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Objective To investigate the association between chronic kidney dysfunction and the complexity of coronary artery disease in elderly patients.Methods A prospective study was conducted on 1380 consecutive patients underwent coronary angiography for the first time in our hospital and with angiographically diagnosed coronary artery disease from January 2011 to June 2012.The complexity of coronary artery disease were classified according to the American College of Cardiology/American Heart Association (ACC/AHA) grading system as types A,B1,B2,and C.Estimated glomerular filtration rate (eGFR) was calculated by the simplified Modification of Diet in Renal Disease(MDRD)equation.Patients were classified into 3 stages according to eGFR as follows:normal renalfunction(n=234,eGFR≥90 ml· min-1 · 1.73 m-2),mild renaldysfunction(n=881,60≤eGFR＜90 ml · min-1 · 1.73 m-2,and moderate or severe renaldysfunction(n=265,eGFR＜60ml · min-1 · 1.73 m-2).Ordinal logistic regression was used to analyze the association between chronic kidney dysfunction and the complexity of coronary artery disease.Results Patients with mild,moderate or severe renal dysfunction were older (F=56.82,P＜0.001),more predominantly female (x2 =66.29,P＜ 0.001) and more likely to have history of hypertension (x2 =17.57,P ＜ 0.001),diabetes (x2=20.97,P＜0.001) and hyperlipidemia (x2=10.48,P 0.005) than those with normal renal function.The percentage of lesions of types B2 or C in moderate or severe renal dysfunction group was higher than that in normal renal function group (x2=175.03,P＜0.001).The ordinal logistic regression showed that age,male,hypertension,diabetes,C-reactive protein and eGFR were independent risk factors for the ACC/AHA lesion classification.Conclusions Age,male,hypertension,diabetes,C-reactive protein and eGFR are independent risk factors for the complexity of coronary artery disease.
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Objective To evaluate the clinical outcomes of emergency intracoronary stenting for senile patients with acute myocardial infarction (AMI). Methods Eighty-four senile patients with AMI underwent emergency intracoronary stenting were compared with eighty-eight non-senile patients with AMI. Results Eighty-six stents were implanted in eighty-four infarction related arteries (IRA), two patients died during hospitalization,the procedural success rate was 97.6% in senile group. Eighty-eight stents were implanted in eighty-eight IRA, one patient died during hospitalization, the success rate was 98.9% in non-senile group. There was no significant difference in characteristic of stents, bleeding complication and LVEF between the senile group and the non-senile group.Conclusion Emergercy intracoronary stenting was an effective and safe therapeutic maneuver for the senile patients with AMI.
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Objective To evaluate the efficacy and safety of intravenous thrombolysis with urokinase combined with emergency interventional therapy for acute myocardial infarction(AMI). Methods Fifty two patients with first AMI (≤12 h from onset)were randomized to thrombolysis plus PCI group and primary PCI group,the patency rate of infarct related artery (IRA) before intervention,the procedural success rate,the incidence of bleeding complications and acute ischemic events during hospitalization and the left ventricular ejection fraction (LVEF) measured by echocardiography before discharge were compared.Results The IRA patency rate in the thrombolysis plus PCI group (61 5%) was significantly higher than that in the primary PCI group (19 2%) ( P 0 05),no major bleeding complication and acute ischemic event occurred during hospitalization in both groups,the LVEF in the thrombolysis plus PCI group (64 3?5 6)% was higher than that in the primary PCI group(54 8?4 9)% before discharge ( P
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0.05).The duration of procedure,fluoroscopy time and amount of contrast media consummed in the transradial angioplasty group were more than those in the transfemoral angioplasty group(54.9?15.2 min vs 40.1?10.6 min,P
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Objective To observe the efficacy and safety of applying platelet glycoprotein Ⅱb/Ⅲa receptor antagonist(tirofiban) during the perioperation period of emergency percutaneous coronary intervention(PCI) in acute myocardial infarction(AMI).Methods Patients with coronary artery TIMI blood flow 0-1 grade and underwent emergency PCI were consecutively randomized into tirofiban group(n=45) and control group(n=45).Tirofiban was used in the former group before operation and continued for 36-48 hours after PCI.In the latter group,PCI was performed through routine process.The reflow rate,30 days reinfarction rate,mortality and platelet activation degree before and after PCI were recorded during the study.Results All patients in the tirofiban group were recovered with TIMI 3 grade flow and neither slow-reflow nor no-reflow phenomena were observed.In the control group 88.90% of patients restored TIMI 3 grade flow and 11.10% of patients were just recovered with TIMI 0-2 grade flow.The difference was found to be statistically significant(P
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Objective To evaluate the short term and long term outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) for acute anterior wall myocardial infarction (AMI) complicated with pump failure Methods 28 patients admitted within 12 hours after the onset of AMI and complicated with heart failure underwent primary PTCA and stent implantation The short term and long term therapeutic effects were observed Results The infarct related coronary arteries (IRCA) of the 28 patients were all LADs with occlusions at the proximal or beginning segment and TIMI flow was 0 Ⅰ Single vessel disease was showed in 15 patients,double vessel disease in 9 and triple vessel disease in 4 The immediate procedural success rate was 100% with TIMI flow Ⅲ in all IRCAs One patient without stent implantation had a recurrent chest pain 2 days after procedure and died of acute pulmonary edema During 1～36 month follow up of the 27 survivors, no death occured and the average LVEF was showed 59 8?6 5% by echocardiography Conclusion Primary PTCA for AMI complicated with pump failure was safe and effective to improve the short term and long term outcomes