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Objective To observe the rates of local complications (bleeding/swelling) after trans-radial coronary intervention (TRI),to investigate possible impact factors,in order to provide guidance for the prevention of these adverse events.Methods A total of 198 cases who performed TRI at the department of interventional cardiology of the First Affiliated Hospital of Sun Yat-sen University from August to December,2011 were included in the present study.Data with regards to local complications were collected peri-operatively,by means of direct inquiry,point-of-care observation and measurements,and laboratory testing.Patients who developed complications and patients who did not were compared in terms of compressor position,loosening protocol and so on.Variables with statistical significance in univariate analysis were further included in Cox regression.SPSS 18.0 software was applied for all statistical analysis.Results The relative risks (RR) of the following two variables,namely whether or not the midpoint of compressor was on the midline of forearm,and the vertical distance from the horizontal plate of the compressor to the puncture site,were 2.602 and 1.403,respectively.Conclusions The midpoint of compressor on the midline of forearm,and the vertical distance from the horizontal plate of the compressor to the puncture site were major risk factors of local complications after TRI.
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Objective To evaluate the value of endothelial function of brachial artery in predicting coronary artery disease in elderly patients. Methods Flow-mediated vasodilation (FMD)and nitroglycerin mediated dilation (NMD) were measured by high-frequency ultrasound in 98 patients with coronary artery disease and 37 controls. All the subjects were diagnosed by coronary arteriography. They were divided into coronary artery blockages ＜ 50% subgroup, 50%-75%subgroup, ＞75% subgroup or coronary blockages in 0, 1, 2, 3 branch (es) subgroups. The correlations between FMD or NMD and the pathological extent or branches of coronary artery were studied and the predictive value of FMD and NMD were analyzed with ROC curve. Results In coronary artery disease group, FMD and NMD were significantly decreased as compared with the control group. They were closely related with coronary artery disease (r= -0. 54, -0. 52, P＜0.01), and were weakly correlated with severity and range of coronary arterial lesion (P＜0. 01).With ROC curve analysis, FMD and NMD could be used to predict coronary artery disease.Conclusions Endothelial function can be used as an index to predict coronary artery disease.
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Objective To investigate the efficacy and safety of tirofiban in the treatment of aged patients with acute coronary syndrome (ACS) during primary percutaneous coronary intervention (PCI). Methods Two hundred and fifty-six patients with ACS who underwent primary PCI were randomly divided into two groups: tirofiban group (tirofiban + PCI treatment, n= 130) and control group (routine PCI treatment, n = 126). Tirofiban group was further divided into two subgroups according to the age: aged group(age ≥60 years, n= 68) and non-elderly group(age<60 years, n=62). At the end of PCI procedure, angiographic features such as thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frames count and TIMI myocardial perfusion grades (TMPG) were analyzed immediately. The incidence of major adverse cardiac events (MACE) was observed within 36 hours and 30 days after PCI, and the incidence rates of thrombocytopenia and bleeding were assessed. Results There was no significant difference between both the two study groups and the two subgroups in the basic clinical or angiographic characteristics before PCI (all P>0.05). There was no significant difference between two groups in TIMI 3 flow achievement rate in culprit vessels after PCI (93.6% vs. 91.3%, χ~2 = 1.02, P= 0.313). In tirofiban group, corrected TIMI frames count was significantly higher than that in control group (31.6±7.7 vs. 23.8±6.1, t = 2.49, P 0.026), and TMPG 3 achievement rate was also higher (83.1% vs. 67.5% ,χ~2=4.05, P=0.046). The incidence of MACE was significantly lower in tirofiban group than that in control group both within 36 hours and 30 days after procedure(6.9% vs. 19.0%, χ~2= 6.30, P= 0.013; 3.8% vs. 11.90%, χ~2= 5.82,P=0.018, respectively). No statistical difference was found in mild bleeding complications between the two groups (20.2% vs. 15.2%, χ~2 =3.65, P=0.065), but the incidence of mild bleeding was higher in aged group than that in the non-elderly group(25.0% vs. 14.5%,χ~2=4.98, P=0.026), and the incidences of serious bleeding and thrombocytopenia were similar between the two subgroups. Conclusions Intravenous tirofiban infusion is safe in aged ACS patients during primary PCI, and has favorable short-term outcomes compared with routine treatment, although there is a slight risk of mild bleeding.
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Objective To investigate the relationship between the levels of circulating pregnancy-associated plasma protein A(PAPP-A,a novel marker of atherosclerotic plaque activity) and myocardial perfusion before or after percutaneous coronary intervention(PCI) in patients with non-ST elevation acute coronary syndrome(NSTEACS).Methods Forty-four patients with high-risk NSTEACS were examined for serum PAPP-A levels,cardiac troponin T and the brachial artery flow-mediated vasodilation(FMD) before PCI.The angiographic data was analyzed before and after PCI in terms of TIMI myocardial perfusion grade(TMPG) in the area of culprit vessels.Results Before PCI,twenty patients with TMPG 1-2 had higher PAPP-A levels(30.41?21.33 mIu/L vs.23.55?18.61 mIu/L,P=0.036) and lower FMD(2.95%?1.71% vs.3.54%?1.58%,P=0.027) companed with the patients with TMPG 2-3.After PCI,twelve patients with TMPG 1-2 had higher PAPP-A levels(35.64?20.58 mIu/L vs.21.87?19.30 mIu/L,P=0.009) and lower FMD(2.26%?1.83% vs.3.95%?1.43%,P=0.018) than those with TMPG 2-3.Conclusion The PAPP-A level and the degree of endothelial dysfunction play roles in myocardial perfusion in patients with high-risk NSTEACS.
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Objective To investigate the short-term effect of PTCA on contractile function of hibernating myocardium. Methods Fifty-three patients with coronary heart disease and segmental dysfunction underwent echocardiography and radionuclide imaging. Echocardiography was repeated one week after PTCA. Results (1) Recovery of contractile function occurred in 87 revascularized segments with dysfunction (87/167, 52.1%) compared with only 2 nonrevascularized segments (2/59, 3.4%) (P