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Objective:To compare the effects of staged percutaneous coronary intervention(PCI)after emergency PCI and emergency culprit-only PCI on clinical outcomes of elderly patients with ST-segment elevation myocardial infarction(STEMI)and multivessel disease.Methods:A retrospective analysis was performed on 389 elderly patients with STEMI and multivessel lesions, aged ≥70 years and within 12 h of onset, admitted to the Clinical College of Thoracic Medicine, Tianjin Medical University, between January 2014 and September 2019.According to different revascularization strategies, enrolled patients were divided into the culprit-only PCI group(79.18%, 308)and the staged PCI group(20.82%, 81). Kaplan-Meier analysis and the Cox proportional hazards regression model were used to compare the incidences of major adverse cardiac and cerebrovascular events(MACCE), all-cause death, cardiac death, recurrent myocardial infarction, stroke and ischemia-driven revascularization between the two groups and to evaluate the effects of different revascularization strategies on MACCE and all-cause death.Then subgroup analysis was performed.Results:During a 56-month follow-up, 131 patients developed MACCE and 96 patients died.Compared with the culprit-only PCI group, the staged PCI group had a lower risk of MACCE( HR: 0.404, 95% CI: 0.227-0.716, P=0.002), all-cause death( HR: 0.354, 95% CI: 0.171-0.730, P=0.005), cardiac death( HR: 0.363, 95% CI: 0.157-0.838, P=0.018), and recurrent myocardial infarction( HR: 0.229, 95% CI: 0.055-0.953, P=0.043). There was no significant difference in the incidence of stroke or ischemia-driven revascularization between the two groups( P>0.05). The reduced risk with staged PCI for MACCE and for all-cause mortality persisted in all subgroups.Multivariate Cox proportional hazards regression revealed that, after adjusting for confounding factors, staged PCI was an independent protective factor for MACCE( HR: 0.44, 95% CI: 0.239-0.815, P=0.009)and for all-cause death( HR: 0.390, 95% CI: 0.90, P=0.020). Conclusion:Compared with culprit-only PCI, staged PCI can significantly improve the long-term prognosis of elderly patients ≥70 years with STEMI and multivessel disease within 12 h of onset.
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Objective To investigate the effects of a new mode of early cardiac rehabilitation after percutaneous coronary intervention (PCI)on the cardiac function recovery,quality of life and incidence of endpoint events in patients with acute myocardial infarction(AMI).Methods A total of 110 AMI patients undergoing PCI at our hospital from August 2016 to July 2017 were selected.The patients were randomly divided into the conventional group(n =55)receiving the conventional cardiac rehabilitation,and the rehabilitation group (n=55)undergoing a new mode of early cardiac rehabilitation after PCI.The cardiac function,health-related quality-of-life score(by SF-36 quality-of-life evaluation scale),and incidence of endpoint events were compared between the two groups before and after cardiac rehabilitation.Results After rehabilitation,the left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume (LVEDV)were significantly lower in the rehabilitation group than in the conventional group(P＜0.01).The health-related quality-of-life scores including societal function,physiological function,physical pain and overall health were significantly higher in the rehabilitation group than in the conventional group(P＜0.05).The incidence of endpoint events was lower in the rehabilitation group than in the conventional group(14.5％ vs.32.7％,x2 =5.037,P=0.025).Conclusions The new model of early cardiac rehabilitation after PCI has a good early nursing effects on AMI patients after PCI,which can not only improve the cardiac function of patients and benefit the prognosis and quality of life,but also reduce the incidence of endpoint events.
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@#Objective Toevaluatetheeffectsofcombinedintracoronaryandintravenous administrationofnicorandil onmyocardialmicrocirculationandshort-termprognosisinpatientswithacuteST-segmentelevationmyocardialinfarction (STEMI)treatedwithprimarypercutaneouscoronaryintervention(PPCI). Methods Atotalof100patientswithacute STEMIunderwentPPCIwererandomlydividedintothenicorandilgroup(patientsreceivedintracoronarybolusinjectionof nicorandilwhenthetargetvesselopenedandthencontinuousintravenousinfusionwithin24hours, n=50)andthecontrol group(patientsreceivednormalsalineascontrol, n=50).Themainoutcomemeasureswereimmediatecoronaryflowand myocardialperfusionafterPPCI,includingthrombo-Lysisinmyocardialinfarction(TIMI)flowgrade,correctedTIMIframe count(CTFC),reperfusionarrhythmia,ST-segmentresolution,plasmacreatinekinaseisoenzyme(CK-MB)peakvalueand time. The secondary indicators were major adverse cardiovascular events (MACE) and left ventricular ejection fraction (LVEF)duringhospitalization.Results Therewerenosignificantdifferencesinhepatorenalfunction,heartrateandblood pressurebeforeandafteroperationineachgroup(P＞0.05).Theincidenceofreperfusionarrhythmia,thelevelofMACE, CTFC,andpeakvalueofCK-MBwereallsignificantlylowerinthenicorandilgroupcomparedwiththoseofcontrolgroup (P＜0.05).TheproportionsofpatientswithTIMI3flow,CK-MBpeaktimein14hours,andtheproportionofST-segment resolutionweresignificantlyhigherinthenicorandilgroupthanthoseofthecontrolgroup(all P＜0.05).Therewasno significant difference in LVEF during hospitalization between two groups (P＞0.05). Conclusion Intracoronary and intravenousadministrationofnicorandilcansignificantlyimproverevascularizationeffects,reducetheoccurrenceofslow flow/noreflow,limitmyocardialinfarctionsize,increasemyocardialperfusionandimprovemyocardialmicrocirculationand theshort-termprognosisofacuteSTEMIpatients.
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Objective To evaluate the efficacy and safety of intracoronary thrombolysis during primary percutaneous coronary intervention(PCI)in elderly patients with acute ST segment elevation myocardial infarction(STEMI).Methods This prospective study was conducted at the Department of Cardiology of Shangqiu First People's Hospital.Elderly patients diagnosed with STEMI and undergoing primary PCI were consecutively recruited from September 2016 to September 2017.Of all recruited patients,106 patients were successfully followed up and were randomly divided into a treatment group(intracoronary thrombolysis group,n=54)and a control group (intracoronary saline group,n=52).Patients in the treatment group received an injection of 10 mg recombinant prourokinase (10 ml)via a balloon catheter while patients in the control group were injected with 10 mL saline instead.The incidences of slow flow,bleeding in 3 days after operation,left ventricular ejection fraction (LVEF),left ventricular end diastolic diameter(LVEDD),and major adverse cardiovascular events (MACE) in 90 days after operation were compared between the two groups.Results Compared with the control group,the treatment group had a decreased incidence of slow flow (x2 =4.06,P＜ 0.05).The incidence of bleeding in 3 days after operation showed no difference between the two groups(x2 =0.71,P＞0.05).The treatment group also had an elevated incidence of LVEF(t=-2.95,P ＜0.05)and a decreased incidence of LVEDD in 90 days after operation(t=2.86,P＜0.05),compared with the control group.No significant difference in the incidence of MACE in 90 days after operation was observed between the two groups(x2 =1.46,P＞0.05).Conclusions In elderly patients with STEMI,intracoronary thrombolysis during primary PCI can reduce the incidence of slow flow during operation,and improve the function and size of left ventricle without increasing the incidence of bleeding.
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Objective To investigate risk factors for in-stent restenosis and reocclusion after coronary stent implantation in aged patients.Methods 131 patients diagnosed with chronic total occlusion and old myocardial infarction due to coronary stenosis were recruited in this retrospective study from Mar 2004 to May 2015.Patients were divided into 50 to 59 years old group (n=51),60 to 69 years old group (n=43),and 70 to 80 years old group (n=37) to study coronary lesion characteristics.In-stent restenosis and reocclusion were detected at 6,12,18,and 24 months after coronary stent implantation.Results Before coronary stent implantation,the incidence rate of type 2 diabetes was significantly increased with three increasing age groups:9.8％ at ages 50-59 group (n=5),18.6％ at ages 60-69 group (n=8),and 27.0％ at ages 70-80 group (n=10) (all-P＜0.01).The incidence rates of multiple coronary artery disease,long coronary lesions (＞20 mm),eccentric coronary lesions,serious angle of coronary lesions,irregular coronary lesions,proximal coronary curvature,moderate to severe calcified coronary lesions,coronary restenosis (90％-99％ or 100％),and complex bifurcation lesions were significantly elevated with three increasing age groups (P ＜0.01 or P ＜0.05).The ratios of patients with in-stent restenosis at 24 months after coronary stent implantation were significantly elevated with three increasing age groups:at 9.8％ (n=5),18.6％ (n=8),and 27.0％(n=10) for 90％ 99％ restenosis sub-group,and at 5.9％ (n=3),14.0％ (n=6) and 24.3％ (n=9) for 100％ restenosis sub-group,respectively (all P＜0.05 or P＜0.01)Conclusions Type 2 diabetes is an independent risk factor for complex coronary lesions in aged patients Complex coronary lesions,three or more stents,and long coronary stents may lead to ir-stent restenosis and reocclusion after coronary stent implantation in aged patients.
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Objective To investigate the relationship between fragmented QRS (fQRS) complexes and the severity of coronary artery lesions in elder patients with complex coronary artery lesions.Methods Two-hundred and one elder patients with complex coronary lesions undergone coronary angiography in Beijing Anzhen Hospital from January 2013 to July 2016 were enrolled.Based on the coronary lesions,patients were divided into the complex coronary lesions group and the simple coronary lesions group.The clinical features and coronary scores were compared between groups.Logistic regression analysis was used to evaluate the risk factors of complex coronary lesions.Results Compared with simple coronary lesions group,the complex coronary lesions group was associated with higher rate of fQRS (31.3％ vs.17.2％,x2 =9.68,P＜0.01),more number of fQRS leads [(1.0±1.5) vs.(0.5±0.8),t=-4.04,P＜0.01],longer duration of QRS [(87.2±10.7) ms vs.(84.1±8.9) ms,t=-3.09,P＜0.01].Moreover,patients with fQRS had a lower level of high density lipoprotein cholesterol (HDL-C) [M(Q25,Q75),0.9 (0.8,1.1) mmol/L vs.1.0 (0.9,1.2) mmol/L,t=-2.84,P＜0.01] and a higher Gensini score [40 (8-76) vs.22 (16-2),t=8.63,P＜0.01] compared with those without fQRS.Furthermore,Logistic regression analysis showed that HDL C (OR=0.346,95％CI:0.163 0.674,P＜0.05),fQRS (OR=2.215,95％ CI:1.381-3.725,P＜0.05) and the number of fQRS leads (OR=4.613,95％ CI:2.412-9.578,P＜0.05) were independent risk factors for patients with high Gensini score,and there was a positive correlation between fQRS and Gensini scores (=0.624,P＜0.01).Conclusions fQRS might be a noninvasive indicator of severity of coronary artery lesions for elder patients with complex coronary lesions.
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Objective To provide supportive evidence for using Clopidogrel in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI). Methods From June 2015 to May 2016,105 cases of CHD were admitted to the Department of Cardiology,the First Affiliated Hospital of Zhengzhou University.Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram was used to detect the rate of Clopidogrel resistance,and adverse cardiovascular events were recorded for 12 months after PCI.Moreover,multivariate Logistic regression was used to analyze risk factors of Clopidogrel resistance. Results A total of 98 cases completed genetic testing for CYP2C19 polymorphisms.Cases with the wild type allele,heterozygous mutations and homozygous mutations accounted for 35.7%,57.1% and 7.1%,respectively.Compared that for wild type cases(49.6 ± 18.5)%,the platelet inhibition rate was significantly reduced for hybrid mutation cases(38.4 ± 15.2)% and homozygous mutation cases(24.8 ± 12.9)%(t=3.142,3.370;P=0.002,0.001,respectively).Meanwhile,based on pharmacokinetic characteristics,the rates of Clopidogrel resistance for patients with the intermediate metabolic type(the heterozygous mutant type) and the slow metabolic type(the homozygous mutant type)were significantly higher than that for patients with the normal metabolic type(the wild type)(χ2 = 5.687,6.363;P< 0.05,respectively). Follow-up results showed that the incidences of adverse cardiovascular events for wild-type and heterozygous mutation patients were 2.9% and 3.6%,respectively,which were significantly lower than that for homozygous mutant patients(28.6%)(χ2 = 5.815,6.540;P< 0.05,respectively). Multivariate Logistic regression analysis showed that risk factors for clopidogrel resistance were glycosylated hemoglobin Alc level,total cholesterol and white blood cell count. Conclusions Genetic testing for CYP2C19 polymorphisms combined with thromboela-stogram can be used as an effective way to evaluate whether Clopidogrel should be used.It is important to measure the platelet aggregation inhibition rate for early detection of Clopidogrel resistance to insure appropriate drug use.
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Objective To compare the clinical curative effects of PTA and simple pharmacotherapy for intrapopliteal artery ischemic disease.Methods Seventy-three patients with intrapopliteal artery ischemic disease were divided into PTA group (n=37) and pharmacotherapy group (n=36).Their ABI,claudication distance,vascular patency,rest pain and amputation rate were recorded and analyzed with SPSS 22.0 at months 1,3,6,12,18 and 24 respectively before and after treat ment.The vascular patency and amputation rate were analyzed according to the Kaplan-Meier curve.Results The ABI was higher in PTA group than in pharmacotherapy group during the 1-24 months following up period after treatment,and was still higher in PTA group than in pharmacotherapy group at month 24 after treatment (0.640±0.238 vs 0.500±0.152,P=0.038).The claudication distance was shorter and the rest pain was milder in PTA group than in pharmacotherapy group at months 1 and 3,and at months 1-18 respectively (P＜0.05,P＜0.01).No significant difference was found in amputation-free survival curves between the two groups (Plogrank =0.618).Conclusion The symptom improvement of PTA is better than that of pharmacotherapy for patients with severe rest pain or severe intermittent claudication.
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Primary percutaneous coronary intervention is a main treatment for acute myocardial infarction.Although there is vast majority of patients with coronary artery to restore blood flow after percutaneous coronary interventional therapy opened the infarction related artery,no reflow phenomenon is frequently observed and seriously affect the prognosis of patients.The occurrence of no reflow in percutaneous coronary intervention (PCI) is associated with a variety of factors and the pathogenic mechanisms that cause this phenomenon are complex and interrelated.So a better understanding of these mechanisms could judge the possibility of no-reflow and promote the development of individualized prevention and treatment strategies are of great clinical significance for the prevention of no-reflow.
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Objective: To explore the distribution features of microvolt T-wave alternation(MTWA) through exercise stress test (EST) in coronary artery disease (CAD) patients with MTWA changes after revascularization. Methods: MTWA was measured in pre-cordial ECG leads in 326 patients with suspected CAD. Based on coronary angiography and coronary CTA, the patients were divided into 4 groups: ① Control group, patients without coronary stenosis, n=101, ② Coronary stenosis<50％ group, n=99, ③ 50％ ≤ Coronary stenosis<70％ group, n=53 and ④ Coronary stenosis ≥ 70％ group, n=73; MTWA was compared among different groups. 95 patients with coronary stenosis ≥ 50％were further divided into 2 subgroups: R (right coronary)stenosis ≥ 50％ subgroup, n=23 and LAD (left anterior descending branch) stenosis ≥ 50％ subgroup, n=72; MTWA was respectively compared to Control group. In addition, MTWA was collected from 103 patients with percutaneous coronary intervention (PCI) as PCI group, MTWA was compared to Coronary stenosis ≥ 70％ group. Results: MTWA was obviously higher in Coronary stenosis ≥ 70％ group than the other 3 groups, all P<0.01. Compared with Control group, Rstenosis ≥ 50％ subgroup had increased MTWA in V4-V6 pre-cordial leads, P<0.05; LAD stenosis≥50％ subgroup had increased MTWA in V1-V2 pre-cordial leads, P<0.01. Compared with Coronary stenosis ≥ 70％group, PCI group showed reduced MTWA, P<0.01. Conclusion: CAD patients with severe coronary stenosis (≥70％) had increased MTWA; MTWA distribution in body surface was approximately corresponding to coronary stenosis site and PCI may decrease MTWA in CAD patients.
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Objective: To observe the lumen structural changes of radial artery (RA) in patients with transradial coronary intervention and the impact of nitroglycerin on the structure by optical coherence tomography (OCT). Methods: A total of 20 patients with transradial coronary intervention were enrolled for OCT imaging to observe and compare the lumen structures of RA between the basic condition and nitroglycerin treated condition. Results: OCT imaging found that 15/20 patients had radial spasm and 1 had intimal tear. Compared to basic condition, with nitroglycerin treatment, the mean lumen diameter, lumen area and total vascular area were increased in the distal, middle and proximal portion of RA, all P<0.001; the intima-media thickness was decreased in the distal, middle and proximal portion of RA, all P<0.001; while the cross section area of tunica media, intimal thickness and extravascular membrane thickness were similar between the basic condition and nitroglycerin treated condition, all P>0.005. Conclusion: Vasodilatation drug may obviously enlarge RA lumen area and total vascular area in patients after transradial coronary intervention.
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Objective: To compare the middle and long term clinical outcomes of one-stop hybrid coronary revascularization, coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in treating the patients with multivessel coronary artery disease; to explore the optimal indication of one-stop hybrid technology. Methods: Our research included in 3 groups: Hybrid group, n=141 patients received one-stop hybrid coronary revascularization in our hospital from 2006-06 to 2010-16. Meanwhile, 5797 patients received CABG and 4254 received PCI, the major pre-operative risk factors were studied by Logistic regression analysis to calculate propensity score, adjacent matching was used to respectively select 141 subjects from CABG and PCI patients to make 1:1 match with Hybrid group as CABG group and PCI group. EuroSCORE and SYNTAX score were used to make risk stratification in all 3 groups. By EuroSCORE system: low risk ≤ 2, medium risk (3-5) and high risk ≥ 6; by SYNTAX score system: low risk ≤ 24, medium risk (25-29) and high risk ≥ 30. The incidence of major adverse cardiac/cerebral vascular events (MACCE) was compared among 3 groups at different risk stratifications. Results: The mean follow-up time was 4.5 years up to 2015-01. The overall incidence of MACCE was lower in Hybrid group (9.9％) than PCI group (27.7％), P<0.001; while it was similar between Hybrid group and CABG group (19.1％), P=0.150. By EuroSCORE stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than both CABG group (P=0.017) and PCI group (P<0.001). By SYNTAX score stratification, the incidence of MACCE in low risk and medium risk patients were similar among 3 groups; while in high risk patients, the incidence was lower in Hybrid group than PCI group (P<0.001), it was similar between Hybrid group and CABG group (P=0.355). Conclusion: One-stop hybrid technology had the better middle and long term outcomes for treating multivessel coronary artery disease patients with high risk stratification, which provided an alternative strategy in clinical practice.
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Objective To investigate the interventional therapy effect of combination application of thrombus aspiration and intracoronary injection of tirofiban for treating heavy thrombosis burden of infarction related vessel in the patients with acute anterior myocardial infarction.Methods The patients with acute anterior myocardial infarction undergone direct primary percutaneous coronary intervention in the hospital were retrospectively analyzed.The group A received simple thrombus aspiration during transcutaneous PCI and the group B received the combination treatment of thrombus aspiration and intracoronary injection of tirofiban in direct PCI.Results The patients with myocardial perfusion grade less than 3 during thrombolysis during myocardial infarction(TIMI) in the group B were significantly less than those in the group A(P＜0.05).The cardiac magnetic resonance imaging(MRI) results indicated that the area of myocardial infarction in the group B was smaller than that in the group A(P＜0.05).The color echocardiography results showed that the left ventricular diastolic volume(LVDV) and left ventricular ejection fraction(LVEF) in the group B were significantly better than those in the group A(P＜0.05).Conclnsion The combination application of thrombus aspiration and intracoronary injection of tirofiban is safe and effective in direct PCI.
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Objective To investigate the value of serum high sensitive C reactive protein(hs-CRP) in the risk stratification and prognosis evaluation in the patients with coronary heart disease and PCI operation.Methods One hundred and sixty-three cases of coronary heart disease and undergoing PCI in this hospital from March 2013 to September 2015 were selected and performed the coronary angiography examination before operation.Then the patients were divided into 3 groups according to the hs-CRP level.The Gensini score was used to judge the blood vessel stenosis degree.The patients were followed up within six months after surgery.The major cardiovascular events were recorded and the relationship between the hs-CRP level with the number of diseased vessels,Gensini score,MACE and other coronary heart disease risk factors was analyzed.Results Hypertension and hs-CRP level had statistically significant difference among 3 groups(P＜0.05);preoperative hs-CRP level showed positive correlation with hs-cTnT level (r =0.44,P＜ 0.001),while the hs-CRP was negatively correlated with the HDL-C level (r =-0.18,P =0.003);with the Gemini score elevation,the hs-CRP level was similarly elevated,the hs-CRP levels in the patients with severe,moderate and mild vascular stenosis evaluated by Gensini's score were(17.11±9.58),(10.02±3.59),(4.11±1.62)mg/L respectively,the difference among them had statistical significance(F=37.21,P＜0.05).Within postoperative six months,the MACE occurrence rates in 3 groups were 32.1％,52.9 ％ and 59.2 ％ respectively,the differences among the three groups were statistically significant(x2 =13.523,P =0.001),and the target lesion blood supply reconstruction rate had statistically significant difference(x2 =7.522,P =0.022).The hsCRP level was an independent risk factor of MACE occurrence(OR =2.06,95 ％ CI:1.31-3.42,P=0.005).Conclusion Serum hs-CRP is an independent risk factor for cardiovascular events occurrence after PCI surgery in the patients with coronary heart disease.
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Objective To compare the effects of nicorandil and trimetazidine on endothelial function and inflammatory cytokines in patients with coronary heart disease after percutaneous coronary intervention (PCI),and to analyze the synergistic effect .Methods 160 patients with coronary heart disease underwent elective PCI were enrolled and randomly divided into four groups ,40cases in each group .The nicorandil group was given nicorandil tab-lets 5mg once time,3 times a day at 72h before PCI.The trimeshamazine group was given trimetazidine tablets 20mg once time,3 times a day.The combined group was given the same dose of nicorandil and trimetazidine .The control group was not given nicorandil or trimetazidine .The changes of CK -MB,cTnI,ET-1,NO,hs-CRP,TNF-αand IL-6 were observed and compared before and after PCI .Results The CK-MB and cTnI in the control group were significantly increased after PCI (t=2.500,3.663,all P<0.05;t=4.168,5.783,4.912,all P<0.05),but there were no statistically significant differences in the other three groups (all P>0.05).The level of cTnI in the control group was higher than that in the other three groups after PCI (F=11.960,15.643,16.078,all P<0.05).After PCI,the levels of ET-1,hs-CRP,TNF-αand IL-6 in the four groups were all significantly increased ( control group:t=6.897,5.293,all P<0.05;t=15.934,16.759,all P<0.05;t=8.516,9.209,all P<0.05;t=6.809, 6.757,all P<0.05;nicorandil group:t=2.254,P<0.05;t=8.903,11.280,all P<0.05;t=5.961,5.992,all P<0.05;t=4.235,4.738,all P<0.05;trimetazidine group:t=3.425,P<0.05;t=10.513,11.582,all P<0.05;t=4.117,5.696,all P<0.05;t =4.130,3.868,all P<0.05;combination group:t =3.180,P<0.05;t =9.204, 10.107,all P<0.05;t=4.839,6.214,all P<0.05;t=5.151,5.883,all P<0.05),and NO level was significantly decreased(control group:t=5.707,5.066,all P<0.05;nicorandil group:t=2.701,2.393,all P<0.05;trimetazi-dine group:t=3.662,3.163,all P<0.05;combination group:t=2.632,2.427,all P<0.05).The levels of ET-1, hs-CRP,TNF-αand IL-6 in the control group were significantly higher than those in the other three groups after PCI(F=9.709,7.794,P<0.05;F=43.772,47.321,P<0.05;F=15.252,10.565,P<0.05;F=5.632,4.372, P<0.05),and NO level in the control group was lower than that in the other three groups (F=14.138,8.374,all P<0.05).The level of NO in the nicorandil group was higher than that in the trimetazidine group (t=2.249,2.305, all P<0.05).There was no synergistic effect between nicorandil and trimetazidine in improving ET -1,NO,hs-CRP,TNF-αor IL-6(P>0.05).Conclusion Both nicorandil and trimetazidine may help to relieve PCI -related myocardial injury , improve endothelial function , inhibit inflammatory factors after PCI , but there is no synergistic effect.Nicorandil may be more effective in improving endothelial function .
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Objective:To investigate the impact of different hospitals on reperfusion time in acute ST-segment elevation myocardial infarction (STEMI) patients from regional cooperative chest pain center (CPC).Methods:A total of 364 STEMI patients received percutaneous coronary intervention (PCI) at 18 months before and after CPC establishment were enrolled.Based on hospital levels,the patients were divided into 2 groups:Initial PCI hospital group,n=197 and Initial non-PCI hospital group,n=167.According to hospital visiting time,Initial PCI hospital group was further divided into 2 subgroups as Green channel subgroup,n=91 and CPC subgroup,n=106;Initial non-PCI hospital group was further divided into 2 subgroups as Routine referral subgroup,n=71 and CPC referral subgroup,n=96.Total ischemia time,from onset to first medical contact (S-FMC) time,from S-FMC to balloon dilatation (FMC2B) time,from hospital visit to balloon dilatation (D2B) time were compared among relevant patients;the impact factors for total ischemia time were studied by multivariate regression analysis.Results:Compared with Routine referral subgroup,the following parameters were shortened in CPC referral subgroup:total ischemia time 325 (236,1185) min vs 367 (214,1340) min,P＜0.05;FMC2B time 115 (82,227) min vs 149 (94,483) min,P＜0.05;D2B time 69 (35,195) min vs 105 (55,260) min,P＜0.05.Compared with CPC referral subgroup,the following parameters were further shortened in Initial PCI hospital group:total ischemia time 283 (168,873) min vs 325 (236,1185) min,P＜0.05;FMC2B time 78 (45,265) min vs 115 (82,227) min,P＜0.05.Multivariate linear regression analysis presented that high school or above education (β=-0.117,P=0.047),arrived PCI hospital within 60 min of onset (β=-0.243,P=0.000)and using initial PCI hospital (β=-0.175,P=0.000) were the independent impact factors for total ischemia time in STEMI patients.Conclusion:Regional cooperative CPC may shorten FMC2B time by patients' referral;visiting PCI hospital within 60 min of onset was the best way to reduce total isehemia time in STEMI patients.
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Objective:To investigate the impact of different hospitals on reperfusion time in acute ST-segment elevation myocardial infarction (STEMI) patients from regional cooperative chest pain center (CPC).Methods:A total of 364 STEMI patients received percutaneous coronary intervention (PCI) at 18 months before and after CPC establishment were enrolled.Based on hospital levels,the patients were divided into 2 groups:Initial PCI hospital group,n=197 and Initial non-PCI hospital group,n=167.According to hospital visiting time,Initial PCI hospital group was further divided into 2 subgroups as Green channel subgroup,n=91 and CPC subgroup,n=106;Initial non-PCI hospital group was further divided into 2 subgroups as Routine referral subgroup,n=71 and CPC referral subgroup,n=96.Total ischemia time,from onset to first medical contact (S-FMC) time,from S-FMC to balloon dilatation (FMC2B) time,from hospital visit to balloon dilatation (D2B) time were compared among relevant patients;the impact factors for total ischemia time were studied by multivariate regression analysis.Results:Compared with Routine referral subgroup,the following parameters were shortened in CPC referral subgroup:total ischemia time 325 (236,1185) min vs 367 (214,1340) min,P＜0.05;FMC2B time 115 (82,227) min vs 149 (94,483) min,P＜0.05;D2B time 69 (35,195) min vs 105 (55,260) min,P＜0.05.Compared with CPC referral subgroup,the following parameters were further shortened in Initial PCI hospital group:total ischemia time 283 (168,873) min vs 325 (236,1185) min,P＜0.05;FMC2B time 78 (45,265) min vs 115 (82,227) min,P＜0.05.Multivariate linear regression analysis presented that high school or above education (β=-0.117,P=0.047),arrived PCI hospital within 60 min of onset (β=-0.243,P=0.000)and using initial PCI hospital (β=-0.175,P=0.000) were the independent impact factors for total ischemia time in STEMI patients.Conclusion:Regional cooperative CPC may shorten FMC2B time by patients' referral;visiting PCI hospital within 60 min of onset was the best way to reduce total isehemia time in STEMI patients.
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Objective To investigate the clinical efficacy and prognosis of early protective pulmonary ventilation and intra-aortic balloon pump(IABP)combined with percutaneous coronary intervention(PCI)in treating patients with acute myocardial infarction(AMI)complicated with cardiogenic shock(CS)and hypoxemia.Methods The 49 patients diagnosed as AMI complicated with CS and hypoxemia and treated with early protective pulmonary ventilation and IABP combined with PCI in Tianjin Chest Hospital from January 2015 to December 2015 were retrospectively analyzed.Major adverse cardiovascular events(MACE)including sudden cardiac death,recurrent myocardial infarction,heart failure and development of target vessel revascularization were recorded during one year of follow-up visits.Survival rate was analyzed and Cox regression analysis was used to explore risk factors for occurrence of MACE after the treatment.Results The revascularization of target vessel was successfully operated on all of the 49 patients.The mean time from attack to hospitalization was(6.2±1.5)hours,while the mean time from emergency room to balloon dilatation was(118.55±28.28)minutes.In these patients,30(61.2%)cases were diagnosed as STEMI,among which 23(76.6%)cases as anterior wall myocardial infarction and 5(16.7%)cases as inferior wall myocardial infarction.While the other 19(38.8%)cases were diagnosed as non-STEMI.Using coronary arteriography,46(93.9%)cases had multi-vessel coronary artery disease,among which 13(26.5%)cases were complicated with severe left main coronary artery disease and 27(55.1%)cases had severe vascular calcification.44(89.8%)cases had TIMI perfusion grade 3 blood flow after PCI,while 5(10.2%)cases did not achieve TIMI grade 3 blood flow.One(2.0%)case had serious complications and 12(24.5%)patients died in hospital.31(63.3%)patients survived 1 year during follow-up visits.Total number of MACE was 32(65.3%).Among these events,18(36.7%)died,4 cases(8.2%)had recurrent myocardial infarction,13 cases(26.5%)had heart failure(HF)and 5 cases(10.2%)had target vessel revascularization(TVR).The total event-free survival rate was 34.7%.Multivariable Cox regression analysis showed that severe vascular calcification〔HR(95%CI):2.677(1.184-6.054),P=0.018〕,TIMI grade blood flow less than level 3 after PCI〔HR(95%CI):26.289(6.314-109.470),P=0.000〕and more than 120 minutes from emergency room to balloon dilatation〔HR(95%CI):2.923(1.325-6.446),P=0.008〕were risk factors for MACE.Conclusions Early protective pulmonary ventilation and IABP combined with emergency PCI are safe and effective for treatment of patients with AMI complicated with CS and hypoxemia.The pattern of treatment can significantly decrease death rate and increase 1-year survival rate.