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Objective To explore the safety and efficacy of policosanol in elder patients with high on-treatment platelet reactivity ( HPR) after drug-eluting stent ( DES) implantation. Methods This study was a prespecified subgroup analysis of the multicenter, randomized SPIRIT trial,in which there were a total of 169 elder patients (≥60 years old) with HPR. Among these patients, 30 patients were in group A ( given clopidogrel 75 mg/d for one year) , 75 patients in group B ( given clopidogrel 150 mg/d for 30 days followed by 75 mg/d until one year ) and 64 patients in group C ( given policosanol 40 mg/d for 6 month and clopidgrel 75 mg/d for one year ) . All patients were treated with aspirin at the same time. The primary endpoint was the reversion rate of HPR at 30 days (reversion was defined as platelet aggregation ﹤65%). The secondary endpoint was 2-year major adverse cardiac events ( MACE ) rate, which included cardiac death, non-fatal myocardial infarction and ischemic symptoms driven target vessel revascularization. The safety endpoint was any bleeding as defined by the Bleeding Academic Research Consortium ( BARC ) definition. Results At 30 days, the reversion rate of HPR in group C was numerically higher as compared with group A ( 42. 9% vs. 23. 3. 0%, P=0. 068 ) , and similar with group B ( 42. 9% vs. 49. 3%, P=0.447). MACE occurred in 4 (13.3%), 5(6.7%) and 3(4.7%) patients in group A, B and C respictively ( P=0. 352). Bleeding events in group A and group C were both markedly lower in comparison to group B (3. 3% vs. 17. 3% vs. 1. 6%, P=0. 001). At the 24-month follow-up, the MACE-free survival rates were not significantly different (95. 3% vs. 93. 3% vs. 86. 7%, P=0. 146). Conclusions For elder patients with HPR, policosanol reduced platelet reactivity to a similar extent in comparison of high maintenance dose of clopidogrel without increasing bleeding risk.
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Objective To explore the post-implant complications of permanent cardiac pacemakers,their reason,treatment and preventive measures.Methods The records of 516 patients receiving a permanent pacemaker were reviewed and complications of the patients were analyzed.Results There were 69 cases of complications after the permanent cardiac pacemaker implantation,5 cases(7.2%) of infection,10 cases(14.5%) of haematoma,7 cases(10.1%) of pocket rankle,10 cases(14.5%) of hemothorax and pneumothorax,10cases(14.5%) of pacemaker syndrome,7 cases(10.1%) of undersensing,2 cases(2.9%) of pacemaker mediated tachycardia,3 cases(4.4%) of battery exhaust advance,3 cases(4.4%) of arrhythmia,10cases(14.5%)of electrode displacement and 2 cases (2.9%) of electrode fracture.Conclusion Good prognosis will be resulted from deep understanding of the usual complications,increased differentiating ability, emphasized pre-operation prevention,standardized operation,strengthened follow-up as well as the education of pacemaker knowledge,early discovery and treatment of the complications.
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Objective To evaluate the safety and feasibility of transradial approach for coronary angiography.Methods Five hundred and ten cases of suspected coronary artery disease received coronary angiography by transradial approach.Results The procedures were successfully performed in 503 cases. Seven failed, of them, three failed in acupuncture, 1 had deformed radial artery,2 were with severe tortuosity of nonname artery and one case was due to left subclavian artery occlusion. The radial artery was occluded in one case after operation.There was no other severe complication. Conclusions Transradial approach for coronary angiography is safe and feasible.Its advantage lies in higher success rate and less complication.
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Objective To evaluate the safety and clinical effect of homemad Costant coronary stent implantation.Methods The immediate and two-year follow-up results of Costant coronary stent implantation in severe coronary heart disease(CHD)patients were retrospectively analyzedin the General Hospital of Shenyang Command of PLA and the Guanzhou People's Hospital from Mar.2001 to Aug.2003.Results Implantation of 86 homemad Costant coronary stents was successfully performed in 71 severe CHD patients although 3 main adverse cardiac events(MACE)occurred during hospitalization(2 patients died and 1 patient had sub-acute in-stent thrombosis).Follow-up was made in 63 patients for(21.5?4.4)months on an average and 4 patients died.Repeat coronary angiogram in 21 patients showed that in-stent restenosis for Costant stent existed in 4 patients and in-stent restenosis in other types of stent was found in 3 patients and in-stent restenosis in all stents was found in 1 patient who died of shock and neo-coronary lesions was found in 5 patients.Costant stent restenosis rate was 7.9%(5/63);MACE rate was only 12.7%(8/63)during follow-up.Conclusion Homemad Costant coronary stent can be safely implanted in severe CHD patients with ideal long-term outcomes.
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Objective To investigate the efficacy and safety of intravenous diltiazem in patients with perioperative angina pectoris in coronary artery revascularization.Methods Totally 128 patients with angina pectoris during perioperation of coronary artery revascularization received intravenous diltiazem.The efficacy was determined by angina symptom,changes of blood pressure (BP) and heart rate (HR),and acute heart events after 2 weeks.Results Ninety-one cases had no relapse and 37 were obviously improved of angina symptoms.BP and HR were safely lowered after intravenous diltiazem.Of the 128 cases,85 received successful PCI and were discharged 1-3 weeks postoperatively;41 of 43 cases successfully received CABG;2 died of ventricular fibrillation and heart failure.There was not side-effect in all patients.Conclusion Intravenous diltiazem is effective and safe for with angina pectoris during perioperation of coronary artery revascularization.
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Objective To evaluate the long-term effect and safety of triple antiplatelet therapy(cilostazol,aspirin and clopidogrel)for the patients with diabetes and acute coronary syndromes(ACS)undergoing percutaneous coronary intervention(PCI).Methods Between December 2004 and February 2006,a randomized,single center trial was conducted in General Hospital of Shenyang Command for comparison of dual and triple antiplatelet therapy after PCI for the patients with ACS.Of 263 diabetic patients enrolled in present study,122 were randomly assigned to standard dual antiplatelet treatment with aspirin and clopidogrel,141 were assigned to triple antiplatelet therapy with aspirin,clopidogrel and cilostazol.Primary endpoint was a composite of cardiac death,non-fatal myocardial infarction(MI),stroke or target vessel revascularization(TVR)at 1 year.Results Baseline clinical and angiographic characteristics were comparable between the two groups.No definite stent thrombosis or MI occurred in either group during the period of follow-up,and no significant difference existed yet in the rates of 1-year cardiac death(4.1% vs 1.5%,P=0.255),stroke(3.3% vs 0.7%,P=0.186)and TVR(12.3% vs 7.8%,P=0.223)between the patients received dual or triple antiplatelet therapy.The rate of primary events was 9.9%(14/141)in triple group,which was significantly lower than that in dual group [18.9%(23/122),P=0.038].Patients receiving hypoglycemic medicine got more benefits from triple antiplatelet treatment.There was no significant difference between the two antiplatelet regimens regarding the risk of hemorrhagic events and premature discontinuation of aspirin or clopidogrel.Conclusion The regimen of cilostazol plus aspirin and clopidogrel for diabetic patients undergoing PCI is effective and safe in reducing long-term adverse cardiac and cerebral-vascular events,especially for the patients with high dangerous DM complicated with ACS.
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60 mm and left ventricular ejection fraction (LVEF)
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80%).Two patients had side lateral vein branches,and 5 patients had side branches of posterolateral veins.There was no significant relationship between the venous variation and sex.The rate of venous variation was higher in patients with noischemic cardiomyopathy than in patients with ischemic cardiomyopathy(91.25% vs 72.72%,P