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Objective To compare the safety and efficacy of direct and remedial rotational atherectomy in the treatment of heavily calcified coronary artery lesions.Methods We retrospectively reviewed 58 patients admitted in the Shanghai Chest Hospital and Liaocheng People Hospital from May 2012 to July 2015 who had received stent implantation and rotational atherectomy.The 58 patients were divided into two groups which were the direct atherectomy group (n =27) and the remedial atherectomy group (n =31).General clinical date,lesion and procedural characteristics,intraoperative complications,in-hospital and follow-up MACCE were compared between the two groups.Results There were no differences between the two groups in general clinical date intraoperative complications,amount of contrast agent used,proceduraltime,rates of in-hospital and follow-up MACCE.Nevertheless,compared with the direct artherectomy group,the remedial group had more number of balloon dilations during procedure [3 (1,5) vs.2 (1,2),P ＜ 0.001] and higher peak cardiac troponin levels [1.1 (0.3,3.0) μg/L vs.0.5 (0.1,2.3) μg/L,P =0.032].Conclusions Remedial rotational atherectomy with drug-eluting stent had the same safety and efficacy as direct atheretomy with drug-eluting stent in treating patients with heavily calcified coronary lesions.It is reasonable and safe to transform routine PCI to remedial rotational atherectomy when the 2.0 mm semi compliant balloon or/and 2.5 mm non-compliant balloon cannot pass through or dilate the lesions.
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Objective To investigate the effect of L-carnitine injection on oxidative stress and clinical efficacy in patients with acute anterior ST segment elevated myocardial infarction ( STEMI ) and received primary percutaneous coronary intervention .Methods 70 patients with acute anterior wall STEMI undergoing primary PCI in our hospital were randomly divided into the L-carnitine treatment group and the control group.Patients in both groups received same standardized treatment including aspirin , clopidogrel, statins, ACEI/ARB etc.after PCI.Serum levels of superoxied dismutase ( SOD ) and malondialdehyde ( MDA) were measured at arrival and 7 days after PCI.Laboratory results and echocardiography finding were compared.Results (1) The serum SOD levels in both groups were elevated on day 7 after treatment (P<0.05).The serum SOD level on day 7 in the L-carnitine treatment group was higher than the control group (P<0.05).(2) The serum MDA levels in both groups were lower 7 days after treatment (P<0.05).The serum MDA level in the treatment group was lower than the control group (P<0.05).(3) Echocardiography exam on day 7 showed left ventricular end diastolic diameter ( LVEDd) and left ventricular ejection fraction (LVEF) were more significantly improved compared with the control group (P<0.05).Conclusions For AMI patients receiving primary PCI , L-carnitine injection can increase serum SOD concentration and reduce the production of MDA , showing inhibiting effects on oxidative stress and has protective effect on myocardia .
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Objective To explore the influence factors of poor myocardial perfusion in patients with ST-segment elevation myocardial infarction( STEMI) after primary percutaneous coronary intervention(PCI). Methods One hundred and forty-three patients with first STEMI who were on admission from April 2010 to May 2014 and underwent primary PCI within 12 hours were enrolled as our subjects. According to the sum-ST-segment resolution(sumSTR)and TIMI myocardial perfusion grade(TMP)after primary PCI,all patients were divided into well myocardial perfusion group( sumSTR ≥ 50% or TMP 2 - 3 grade)and poor myocardial perfusion group(sumSTR < 50% and TMP 0 - 1 grade). The influence factors between two groups were collected and analyzed,including sex,age,pain to balloon time,blood pressure on admission,left ventricular ejection fraction,leucocyte count,neutrophil ratio(NR),high-sensitivity C-reactive protein(hs-CRP),blood lipid,and the history of hypertension,diabetes mellitus. Results The leucocytes count,NR,hs-CRP in patients of poor myocardial perfusion group were(11. 60 ± 3. 57)× 109 / L,0. 84 ± 0. 06 and 9. 80 ± 11. 37 mg/ L,higher than those in well myocardial perfusion group((9. 51 ± 2. 59)× 109 / L,0. 77 ± 0. 11 and(3. 83 ± 5. 58)mg/ L),and the differences were significant(t = 3. 497,P = 0. 001;t = 3. 390,P = 0. 001;t = 3. 973,P < 0. 001). Multiple linear regression analysis showed that neutrophil ratio was independent risk factor of sumSTR in STEMI patient after primary PCI(P = 0. 000). Conclusion The increase of leucocyte count,NR and hs-CRP are related to the poor myocardial perfusion after primary PCI. The increase of neutrophil ratio is an independent risk factor of poor myocardial perfusion.
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Objective To evaluate the efficiency and safety of domestic rapamycin-eluting stent(Firebire stent) in the treatment of coronary heart disease.Methods Coronary angiography and stenting were carried out through femoral artery approach in 331 patients with coronary heart disease.The incidences of in-hospital major adverse cardiac events were recorded all the patients were followed up for 1 year.The follow-up angiography was carried out at at 6-9 months after discharge.Results A total of 597 domestic rapamycine-eluting stents were implanted in 331 patients.One patient died of pump failure after primary PCI and another patient required emergency CABG because of coronary artery rupture.NSTEMI happened in 3 patients after PCI.The incidence of in-hospital MACE was 1.5%.Three hundred and one patients finished a mean follow-up of 12.3?3.2 months.During the follow up period,non-fatal myocardial infrarction was recorded in 1 case,recurrent angina in 16 cases and target lesion revascularization in 5 cases.The overall MACE rate was 4.3%.Follow-up angiography was completed in 110 patients and the restenosis rate was 5.5%(6/110).Conclusion Domestic rapamycin-eluting stent(Firebird stent) was safe and effective in the treatment of coronary heart disease and may provide a higher cost-effectiveness due to its relatively low price.However,its long-term effect needs more studies to verify.