Simultaneous measurement of cardiac troponin I, natriuretic peptide, and C-reactive protein for the prediction of long-term cardiac outcome after cardiac surgery / 中国基层医药

Objective To investigate the clinical value of simultaneous assessment of cardiac troponin I,Btype natriuretic peptide,and C-reactive protein in prediction of long-term cardiac outcome after cardiac surgery.Methods 224 patients undergoing cardiac surgery were included and followed up within 12 months after surgery.Serial blood samples were drawn in all patients the day before surgery,at the end of surgery,and 6,24,and 120h after surgery.Major adverse cardiac events within 12 months after surgery were chosen as study endpoints and were defined as malignant ventricular arrhythmia,myccardial infarction,congestive heart failure,the need for myocardial revascularization,and/or death from cardiac cause.Predictive ability of each cardiac biomarker was assessed using logistic regression.Results Accuracies of C-reactive protein,cardiac troponin I,and B-type natriuretic peptide,considered as continuous variables to predict the occurrence of major adverse cardiac events were limited(area under receiver operating characteristic curve:0..54[0.47 ～0.60],P =0.42,0.62[0.55 ～0,68],P =0.01,and 0.68[0.61 ～0.74],P ＜0,001,respectively).When biomarkers were considered as 75％ specificity dichotomized variables,evaluated C-reactive protein(＞ 180mg/L),cardiac troponin I(＞ 3.5ng/ml),and B-type natriuretic peptide (＞ 880pg/ml)were independent predictors of major adverse cardiac events(odds ratio:2.14[1.03 ～4.49],P =0.043,2.37 [1.25 ～ 5.64],P =0.011,and 2.65 [1.16 ～ 4.85],P =0.018,respectively) in a multivariate model including the European System for Cardiac Operative Risk Evaluation score.Conclusion Simultaneous measurement of cardiac troponin I,B-type natriuretic peptide,and C-reactive protein improves the risk assessment of long-term adverse cardiac outcome after cardiac surgery.

Firebird stent for the treatment of patients with coronary heart disease: short-term clinical outcome / 老年心脏病学杂志（英文版）

Objective The sirolimus-eluting stent (SES) has dramatically reduced the rate ofrestenosis in comparison to that with the bare-metal stent (BMS).This study aimed to evaluate the short-term efficacy and safety of Firebird stent implantation for patients with coronary heart disease (CHD). Methods From Apri12006 through July 2007, 155 patients (mean age 58.93～10.27 years) with CHD were implanted with Firebird stent or Cypher select stent at Daxing Hospital. Patients were followed up for one year. All-cause mortality, major adverse cardiac events (MACE, including cardiac death, myocardial infarction, recurrence of angina pectoris, heart failure, revascularization, and adverse arrhythmia) and stent thrombosis were compared between the 2 groups. Results Of the 155 consecutive patients, 147 patients were revascularized completely. Of these patients, 48 (with 59 lesions) were treated with Firebird stent, 59 patients (with 75 lesions) with Cypher select stent. The demographic characteristics were similar in the 2 groups. All the angiographic and procedural results were not significantly different between the 2 groups. All-cause mortality, myocardial infarction, recurrence of angina pectoris, MACE and stent thrombosis were almost identical between the 2 groups before discharge, at 6 months and at one year .Conclusion The short-term efficacy and safety of Firebird stent are similar to that of the cypher select stent for the treatment of patients with CHD.

Different therapeutic proportion of patients undergone coronary angiography in the era of development in MSCT / 老年心脏病学杂志（英文版）

Objective To study the different therapeutic proportion of the patient populations undergone coronary angiography (CAG) in the era of development in multislice spiral computed tomography(MSCT).Methods Two hundred and fifty four consecutive patients(mean age 59.24±10.65),who underwent CAG at Daxing Hospital from February 2007 through October 2007,were enrolled,160 patients were male and 94 were female.By evaluating from the coronary angiogram,the patients were not diagnosed to have coronary heart disease(CHD) with less than 50% diameter stenosis of coronary artery;the patients to have CHD with more than or equal to 50% stenosis of coronary artery;the patients were performed the procedure of percutaneous coronary intervention(PCI) with more than or equal to 70% stenosis;the patients were proposed to have coronary aortic bypass graft(CABG) surgery with left main coronary artery lesions or diffuse triple coronary artery lesions.Results In the 254 consecutive patients,59 patients(23.2%) had not been diagnosed to have CHD;195(76.8%)to have CHD,of these patients with CHD,49 patients(19.3%)were not indicated for PCI (including the patients receiving follow-up coronary angiography after stenting),81(31.9%)had been performed the procedure of stent implantation,57(22.4%)proposed to have CABG,8(3.1%)the procedure of PCI had not been successful,or had not been performed because of patients opposing to this therapy.Conclusion Multislice spiral computed tomography can be applied as a non-invasive screening tool to exclude the presence of CHD,to increase the positive proportion of the populations with CHD in all patients receiving coronary angiograhpy,to avoid the use of CAG in a subset of patients.

Clinical analysis of coronary artery bypass grafting in 218 cases / 临床外科杂志

Objective To summarize the results and experience of coronary artery bypass grafting for coronary artery disease.Methods From Jan. 2001 to Apr. 2002, 218 patients underwent coronary artery bypass grafting. Male 143, female 75. Coronary artery bypass grafting with extracorporeal circulation(ECC) in 152 patients, off-pump coronary artery bypass grafting in 66 patients. Surgical technique, perioperative treatments, death causes and complications were analyzed in all cases.Result 5 patients died in hospital, mortality was 2.3%(5/218), others had favorable outcomes.Conclusions Strict mastery of surgery indictions, advanced oprative methods, excellent myocardial protection and perfect perioperative treatments are pivotal factors of CABG, the efficacy and safety of coronary artery bypass grafting are satisfactory.

The surgical therapy of senile patients over the age of 70 with coronary heart disease / 临床外科杂志

Objective To evaluate the results of coronary artery bypass grafting in forty-one senile cases no less than seventy years old with coronary heart disease. Method Retrospectively analyzed the operative results of 41 cases of CABGs (17-case of OPCABs and 24-case of conventional CABGs(CCABGs))with the age no less than 70 years old from Dec.20 2000 to Jan.31 2002.Results The average bypass grafts per patient was 2.1?0.6 in OPCAB group and 3.4?0.7 in CCABG group(P

Deep Sternal Wound Infection after Cardiac Surgery / 中华医院感染学杂志

OBJECTIVE Deep sternal wound infection (DSWI) is one of the most serious complications after the open heart cardiac surgery. To explore the risk factors and appropriate treatment methods,we performed this study retrospectively. METHODS Between Jan 2001 and Jan 2006,1123 patients underwent various cardiac surgical procedures via a median sternotomy in the Cardiovascular Center of Beijing Tongren Hospital. These patients were divided into two groups by whether suffered from DSWI. Univariate analyses were performed for possible risk factors,and Logistic regression was used in multivariate analysis. RESULTS Eight among 1123 (0.71%) patients suffered from DSWI. No one died from wound infection. Results from both single variate analysis and multivariate analysis showed that only age significantly associated with DSWI. No other independent risk factors significantly associated with DSWI. Blood culture in acute DSWI group tended to be positive,while in chronic group it tended to be negative. All patients with DSWI were effectively cured. CONCLUSIONS Age is an independent risk factor for DSWI. Early debridement with closed chest catheter irrigation and antibiotics using are strongly recommended as an easy and effective way to treat DWSI. Large-scale multicenter studies are still needed to determine reliable risk factors for DSWI.