ABSTRACT
Objective:To investigate the effects of applying Stent Boost Subtract (SBS) technique during percutaneous coronary intervention in patients with complex coronary lesions.Methods:200 patients with coronary artery disease (CAD) who hospitalized in the department of cardiology in Guangzhou First People′s Hospital from June 2018 to June 2020 were enrolled. The coronary lesions of all patients were corresponding to B2 or C type suggested by American Heart Association (AHA)/American College of Cardiology (ACC) according to coronary angiography and treated with percutaneous coronary intervention (PCI). Patients were randomly divided into SBS group ( n=82, SBS technique was applied during PCI) and IVUS group [ n=118, intravascular ultrasound (IVUS) was applied during PCI]. After stent implantation, quantitative coronary angiography (QCA) automatic analysis system was used to measure the related parameters of stent diameter (including the minimum, maximum and mean value of stent diameter) and calculate the stent eccentricity index. During PCI, stent eccentricity index, post-stent expansion, poorly positioned stent with open lesions, failure of overlapping stent with long lesions, mean cumulative dose (CD), product of total dose area (DAP), X-ray time, operation time and operation cost of each PCI were recorded in the two groups. Patients were followed up for 18 months after PCI, and the occurrence of adverse cardiovascular events (MACE) was recorded during the follow-up period, and the cumulative survival rate without MACE was compared between the two groups. Results:There were no statistically significant differences between the two groups in stent eccentricity index, proportion of guided stent expansion, proportion of poorly positioned stent with open lesions, proportion of stent failure to overlap, with statistically significant difference[(0.12±0.04) vs (0.10±0.03); 80.49% vs 85.49%; 2.44% vs 2.54%; 1.22% vs 2.54%, all P>0.05]. There were no significant differences in CD, X-ray time and DAP in SBS group compared with IVUS group [(1 394.18±42.29)Gy/cm 2 vs (1 391.82±45.06)Gy/cm 2; (18.79±3.01)min vs (18.95±3.12)min, (100.24±5.70)Gy/cm 2 vs (99.47±5.93)Gy/cm 2; all P>0.05]. The operation time in SBS group was shorter than that in IVUS group [(70.91±6.51)min vs (73.89±8.95)min, P<0.05], and the operation cost was less than that in IVUS group [(2.98±0.86)ten thousand yuan vs (3.85±0.81)ten thousand yuan, P<0.05]. After 18 months of follow-up after PCI, Kaplan-Meier survival analysis showed that there was no significant difference in MACE event-free survival between SBS group and IVUS group (91.46% vs 94.07%, Log Rank=0.480, P=0.489). Conclusions:SBS is a kind of convenient and effective technique in guiding PCI in patients with complex coronary lesions without increasing operation time and radiation dose, which can achieve the same effect as IVUS guidance.
ABSTRACT
Objective To investigate the correlations of risk factors of age,delirium-inducing factors,dementia,delirium severity,and disease severity with the prognosis of elderly patients with delirium.Methods A total of 112 patients aged 70 years and older with initial onset of delirium during hospital stay were enrolled in this study.They were hospitalized in Dalian Municipal Central Hospital from Jan.2013 to Dec.2015.The severity of delirium was evaluated by delirium rating scalerevised-98(DRS-R-98).The acute physiology and chronic health enquiry(APACHE-Ⅱ)score and the sequential organ failure assessment(SOFA)score were recorded within 48 h after delirium onset.After periods of hospitalization of Jan.2013 to Dec.2015,patients were followed up until 31 Dec 2017.Correlations of age,delirium-inducing factors and dementia with survival time and long-term viability after delirium onset were statistically analyzed.Results Age,delirium-inducing factors,cognitive impairment,duration of cognitive impairment,type of dementia,and delirium severity had no correlations with the lifetime and long-term viability in patients with delirium.While,APACHE Ⅱ score for assessment of severity degree of delirium(P ＜0.001,r =-0.390) and SOFA score(P ＜0.001,r=-0.638)were negatively correlated with the lifetime in patients with delirium.SOFA score (P =0.004) and delirium recurrence (P ＜ 0.001) were significantly correlated with the long-term viability in patients with delirium.Conclusions The severity and recurrence of delirium are strongly correlated with the lifetime and quality of life in patients with delirium.Compared with APACHE Ⅱ score,SOFA score may have a more important clinical application value in predicting the prognosis of patients with delirium.