ABSTRACT
Objective@#To evaluate the impact of various anticoagulation antiplatelet therapy strategies on the prognosis of patients with coronary heart disease combining with atrial fibrillation.@*Methods@#Present meta analysis was performed according to search results on English EMBASE database by computer retrieval, Pubmed, the Cochrane Central Register of Controlled Trials, Medline, Chinese CBM database, CNKI database, Wan Fang database, China science and technology papers online electronic databases, manual retrieval for important international conference proceedings up to April 30 2016. Trials published in English and Chinese language, which met the Cochrane system evaluation requirements were included and the inclusion and exclusion criteria were made based on Cochrane system evaluation requirements. The end point is the incident of major adverse cardiac events (MACE), ischemic stroke and major bleeding events. The patients were randomly assigned into triple antithrombotic therapy (aspirin+ clopidogrel+ warfarin) group and dual antiplatelet therapy (aspirin+ clopidogrel) group.The collected full-text literatures underwent further quality assessment of the risks of bias using RevMan 5.3 software. Impact of various antithrombotic therapeutic strategies on the outcome of coronary heart disease patients combining with atrial fibrillation were evaluated.@*Results@#In this meta analysis, 12 randomized controlled trials with 11 353 patients were included. Among these patients, 3 486 patients received triple antithrombotic therapy and 7 867 patients received dual anti-platelet therapy. There was no significant difference in incidence rate of MACE (OR=0.93, 95%CI 0.74-1.18, P>0.05) and the incidence rate of ischemic stroke (OR=0.88, 95%CI 0.70-1.10, P=0.27) between the two patients groups. However, the incidence rate of major bleeding events in triple antithrombotic therapy group was twice higher than that in dual anti-platelet therapy (OR=1.94, 95%CI 1.33-2.82, P=0.000 6).@*Conclusion@#Compared with dual anti-platelet therapy strategy, coronary heart disease patients combining with atrial fibrillation who were treated by triple antithrombotic therapy strategy have the similar outcome on risk of ischemic stroke, but higher risk of major bleeding events.
ABSTRACT
Objective:To explore risk factors for no‐reflow after emergency coronary intervention in aged patients with a‐cute ST elevation myocardial infarction (STEMI) . Methods:According to presence of no -reflow (≤TIMI grade Ⅲwas considered as no-reflow) after operation or not ,a total of 700 aged STEMI patients hospitalized in our hospital during 2010-2013 were divided into no-reflow group (n=190 ,27. 14% ) and reflow group (n=510 ,72. 86% ) . Clinical data , PCI and coronary angiography data were collected ,compared and analyzed between two groups . Results:Compared with reflow group ,there were significant rise in percentages of patients with TIMI grade 0-1 (61.17% vs. 82.11% ) ,coro‐nary collateral blood flow grade 0 (64.12% vs. 74.21% ) ,5 thrombus scores before PCI (58.83% vs. 80.00% );signifi‐cant reduction in systolic blood pressure (SBP) at hospitalization [ (111.2 ± 24.6) mmHg vs. (101.7 ± 25.9) mmHg] in no-reflow group , P<0. 01 all. Multi-factor Logistic regression analysis indicated that SBP<101 mmHg at hospitaliza‐tion ,collateral blood flow grade 0 before PCI and 5 thrombus scores before PCI were risk factors for no‐reflow after emer‐gency PCI (OR=1.006~4.398 , P<0.05 or <0.01) .Conclusion:In aged acute STEMI patients ,those with risk factors for no-reflow after emergency PCI should take corresponding preventive and therapeutic measures in order to improve their prognosis .
ABSTRACT
Relata-se o caso de paciente masculino, 55 anos, com infarto agudo do miocárdio com supradesnivelamento de ST em parede anterolateral, classe Killip III. Cinecoronariografia de urgência evidenciou tronco da coronária esquerda ocluído, com alta carga trombótica que se estendia para a raiz da aorta. Foi realizada intervenção coronariana percutânea primária com balão, associada à trombectomia aspirativa e trombólise química locorregional intracoronariana, sem necessidade de implante de stent. O paciente apresentou evolução clínica satisfatória e recebeu alta hospitalar após 15 dias.
Case report on a 55-year-old male with antero-lateral ST elevation myocardial infarction, Killip class III. Urgent coronary angiography revealed an occluded left main coronary artery and high thrombotic load that extended to the aortic root. Primary percutaneous coronary intervention was performed with a balloon catheter, associated with aspirative thrombectomy and intracoronary chemical thrombolysis, with no need for a stent implant. The patient presented good clinical progress and was discharged from the hospital fifteen days later.