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Objective:To explore the safety and efficiency of percutaneous coronary intervention (PCI) in maintenance hemodialysis patients combined with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods:The clinical data of 52 maintenance hemodialysis patients combined with NSTE-ACS from January 2010 to January 2015 in Dalian Central Hospital were retrospectively analyzed. Among of them, 25 patients were treated with common drugs (control group), and 27 patients were treated with common drugs combined with PCI (PCI group). The major adverse cardiac events (MACE) duration of hospital stay were record, including hemorrhage, malignant arrhythmia, new heart failure or aggravation, stroke and all-cause death. The dialysis complications within 1 month after treatment were recorded, including hypotension, arrhythmia, heart failure and angina pectoris. The patients were followed up for 12 months, the MACE 1, 6 and 12 months after treatment were recorded, including angina pectoris, heart failure and cardiac death.Results:Duration of hospital stay, the incidences of malignant arrhythmia and new heart failure or aggravation in PCI group were significantly lower than those in control group: 18.5% (5/27) vs. 44.0% (11/25) and 7.4% (2/27) vs. 32.0% (8/25), and there were statistical differences ( P<0.05); there were no statistical difference in the incidences of hemorrhage, stroke and all-cause death between the two groups ( P>0.05). The incidences of dialysis complications such as hypotension, arrhythmia, heart failure and angina pectoris within 1 month after treatment in PCI group were significantly lower than those in control group: 24.0% (6/25) vs. 56.5% (13/23), 16.0% (4/25) vs. 43.5% (10/23), 12.0% (3/25) vs. 47.8% (11/23) and 24.0% (6/25) vs. 52.2% (12/23), and there were statistical differences ( P<0.05 or <0.01). The follow-up results showed that the incidences of angina pectoris and heart failure 1, 6 and 12 months after treatment in PCI group were significantly lower than those in control group, angina pectoris: 28.0% (7/25) vs. 65.2% (15/23), 29.2% (7/24) vs. 76.2% (16/21) and 43.5% (10/23) vs. 17/17, heart failure: 16.0% (4/25) vs. 43.5% (10/23), 8.3% (2/24) vs. 33.3% (7/21) and 21.7% (5/23) vs. 10/17, and there were statistical differences ( P<0.05 or <0.01); there was no statistical difference in the incidence of cardiac death 1 and 6 months after treatment between two groups ( P>0.05), the incidence of cardiogenic death 12 months after treatment in PCI group was significantly lower than that in control group: 8.6% (2/23) vs. 9/17, and there was statistical difference ( P<0.01). Conclusions:PCI is safe and effective for maintenance hemodialysis patients combined with NSTE-ACS.
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Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.
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Objective To compare 12-month follow-up clinical outcome of an early to a delayed intervention in the management of high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods 758 consecutive high-risk NSTE-ACS patients treated with percutaneous coronary artery intervention(PCI)were enrolled between Jauary 2015 and December 2015 in Wuhan Asia Heart Hospital. They were divided into 2 groups according to diff erent intervention time, the early PCI group(within 24 h after diagnosis,n=185)and the delayed group (more than 24 h after diagnosis, n=573).The baseline clinical data, angiographic features, data related to PCI, the 12-month follow-up major adverse cardiac events (MACE) were analyzed retrospectively. MACE were defi ned as all-cause death and recurrent nonfatal myocardial infarction. Results Primary endpoint status after 12-month follow-up were collected in 711 of 758 initially enrolled patients. Incidence of MACE was 14.5% in the early and 11.2% in the delayed PCI group(χ2=1.289,P=0.256). No signifi cant diff erences were found in the occurrence of the individual components of all-cause death and nonfatal myocardial infarction. Mean hospital stay were(7.6±3.1)d in the early and (10.7±3.8)d in the delayed PCI group(t=2.489,P=0.014). Mean medical expenses in RMB were(48.5±13.5) thousand yuan in the early and(52.8±16.4)thousand yuan in the delayed PCI group(t=2.132,P=0.038). Conclusions After 12-month follow-up,no diff erence in incidence of MACE was seen between early and delayed invasive strategy,but with shorter hospital stay and reduced medical expenses.
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OBJECTIVE:To evaluate the effects of loading-dose rosuvastatin on vascular endothelial function in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) after early interventional therapy. METHODS:Totally of 128 NSTE-ACS patients underwent early interventional therapy were randomly divided into conventional dose group (63 cases) and loading dose group(65 cases). Before operation,all patients were given Clopidogrel sulfate tablets 300 mg and Aspirin enteric-coat-ed tablets 100 mg;on this basis,conventional dose group was given Rosuvastatin calcium tablets 10 mg orally;loading dose group was given Rosuvastatin calcium tablets 20 mg orally. After PCI,both groups were given Rosuvastatin calcium tablets 10 mg orally, qd,and Aspirin enteric-coated tablets(100 mg/d)and Clopidogrel sulfate tablets(75 mg/d),for consecutive 3 months. The blood samples were collected before surgery,8 h and 24 h after surgery. The serum levels of CK-MB,cTn T,hs-CRP,ET and NO were detected. The occurrence of major adverse cardiovascular events was recorded within 3 months after surgery. RESULTS:Compared with before surgery,the serum levels of CK-MB,cTn T,hs-CRP and ET were increased significantly 8 h and 24 h after surgery, while the level of NO was decreased,with statistical significance (P0.05). CONCLUSIONS:For NSTE-ACS patients underwent ear-ly interventional therapy,loading dose of rosuvastatin can protect the patients and inhibit the injury of vascular endothelial cell in-duced by the surgery.
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<p><b>BACKGROUND</b>It has been shown that administration of statins reduced the risk of peri-procedural myocardial damage. However, it remains unclear whether Chinese medicine Danlou Tablet (), similar to statins, may protect patients undergoing percutaneous coronary intervention (PCI) from peri-procedural myocardial damage.</p><p><b>OBJECTIVE</b>To demonstrate the hypothesis whether treatment with Danlou Tablet would improve clinical outcome in patients undergoing selective PCI with non-ST elevation acute coronary syndrome (NSTE-ACS) in China.</p><p><b>METHODS</b>Approximately 220 patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI will be enrolled and randomized to Danlou Tablet treatment (4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90 days thereafter) or placebo. All patients will not receive Danlou Tablet before procedure. The primary end point is to evaluate the incidence of cardiac death, myocardial infarction or unplanned re-hospitalization and revascularization after 30 days in patients undergoing selective PCI treated with Danlou Tablet compared with placebo. Secondary endpoints include the incidence of peri-procedural myocardial injury, 3-month clinical outcomes, the quality of life and Chinese medicine syndromes assessment.</p><p><b>CONCLUSION</b>This study protocol will provide important evidence of Danlou Tablet treatment on the peri-procedural myocardial injury in patients with NSTE-ACS undergoing selective PCI, which may support a strategy of routine Danlou Tablet therapy to improve the clinical outcomes.</p>
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Humans , Acute Coronary Syndrome , Diagnostic Imaging , Drug Therapy , Drugs, Chinese Herbal , Therapeutic Uses , Electrocardiography , Endpoint Determination , Myocardium , Pathology , Percutaneous Coronary Intervention , Sample Size , UltrasonographyABSTRACT
Objective To observe the therapeutic effect of Qilin Xintongshu pill for treatment of patients with non-ST segment elevation acute coronary syndromes(NSTE-ACS)accompanied by gastrointestinal bleeding (GIB). Methods A prospective randomized controlled trial was conducted. A total of 67 hospitalized patients in Cardiovascular Department of Qionghai City Hospital of Traditional Chinese Medicine were divided into therapy group(35 cases)and control group(32 cases). Both groups were given conventional medical treatment(except anti-coagulative agent). In the therapy group,the patients received Qilin Xintongshu pill(the ingredients consisting of panax pseudo-ginsen,dragon's blood,immature orange fruit,etc.)oral administration,once 5 mg and 3 times a day,while in the control group,the patients accepted clopidogrel orally,once 75 g and once a day,the therapeutic course in both groups being 30 days. The major cardiovascular events(such as death,a newly-happened myocardial infarction(MI),MI secondary,obstinately ischemia)and incidence of massive hemorrhage of gastrointestinal tract were compared between the two groups,and the adverse events were observed. Results After treatment,the incidence of cardiovascular events and massive hemorrhage of gastrointestinal tract in the therapy group were decreased significantly compared to those in the control group 〔incidence of cardiovascular events:8.57%(3/35)vs. 28.13%(9/32), incidence of massive hemorrhage of gastrointestinal tract:2.86%(1/35)vs. 21.88%(7/32),both P<0.05〕. Adverse events were not observed in both groups,and the examinations of blood,urine,liver and renal functions were of no abnormalities before and after treatment. Conclusion Qilin Xintongshu pill can effectively reduce the incidences of cardiovascular events and massive hemorrhage of gastrointestinal tract in patients with NSTE-ACS accompanied by GIB in the therapeutic course of 30 days,therefore this traditional Chinese herbal medicine is an ideal agent for treatment of such disease.