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【Objective】 Coronary no-reflow during percutaneous conranary intervention (PCI) often results in the failure of ischemic myocardial reperfusion and major adverse cardiovascular events (MACE). The present study sought to evaluate whether the GRACE risk score can predict coronary no-reflow in STEMI patients undergoing PCI. 【Methods】 We consecutively recruited 1 118 patients with STEMI who were admitted to Gansu Provincial People’s Hospital and The First Affiliated Hospital of Xi’an Jiaotong University from January 2009 to December 2011. Main demographic data, cardiovascular risk factors, blood lipid and other biochemical indicators were recorded. Coronary angiography was performed by a radial artery approach using the standard Judkins technique. Coronary no-reflow was evaluated by at least two independent experienced cardiologists. The GRACE risk score was calculated with a computer program. All the cases were followed up by medical records, face-to-face interviews or telephone calls. Finally, we analyzed the predictive value of the GRACE risk score for coronary non-reflow and MACE in STEMI patients undergoing PCI. 【Results】 During a median period of 36 months, 58 of the 1 118 patients (5.2%) were lost to follow-up. Of the remaining 1 060 patients, 118 (11.1%) had no-reflow and 147 (13.9%) had MACE. The GRACE score was higher in patients with no-reflow than those without no-reflow. Multivariate logistic regression established that the GRACE score was an independent predictor for coronary no-reflow (OR=1.034; P=0.002). And multivariate Cox analysis showed the GRACE score was an independent predictor of MACE. The area under the ROC curve for coronary no-reflow and MACE was 0.719 and 0.697, respectively. Kaplan-Meier analysis showed that the probability of rehospitalization for heart failure, reinfarction, all-cause death and cumulative cardiovascular events increased with the increase of the GRACE risk score. 【Conclusion】 The GRACE risk score is a readily available predictive scoring system for coronary no-reflow and MACE in STEMI patients.
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Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.
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<b>Objective::Evaluate the effects of Danhong injection for perioperative percutaneous coronary intervention (PCI) on cardiac function and thrombolysis in myocardial infarction (TIMI) in patients with acute myocardial infarction (AMI). <b>Method::Computer retrieving CNKI, Wanfang database, VIP database, PubMed, CBM, Web of Science, The Cochrane Library, gathering Danhong injection in percutaneous coronary intervention perioperative application in the treatment of acute myocardial infarction clinic trials. The Cochrane risk evaluation is adopted to improve the quality of literature evaluation, with Revman 5.3 software for Meta-analysis. <b>Result::Participants included in 12 clinic trials contains a total of 1 131 patients, including 569 patients in Danhong treatment and 562 patients in control group. The results showed that compared with conventional treatment, Danhong injection treated patients had LVEF increased obviously [mean difference (MD)=6.62, 95% confidence interval (CI) (4.91, 8.34), <italic>P</italic><0.000 01], the number of TIMI class 3 patients significantly increased[relative risk (RR)=0.22, 95%CI(0.12, 0.41), <italic>P</italic><0.000 01], and BNP levels significantly decreased [MD=151.86, 95%CI (-247.00, -56.72), <italic>P</italic>=0.002]. <b>Conclusion::Danhong injection can improve the function of acute myocardial infarction after percutaneous coronary intervention.
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Objective: To explore effect of modified Guifu Dihuang Wan (Wenshen Huoxue Fang) on life quality in patients with coronary hear disease (CHD) after percutaneous coronary intervention (PCI) and evaluate the safety of its clinical use. Method: The 147 postoperative patients with PCI in Chongqing Traditional Chinese Medicine Hospital cardiology outpatient and the inpatient departments between June 2017 to May 2018 were selected and randomly divided into the treatment group and control group by random even and odd number. The patients in control group took the basic treatment (western medicine), and the patients in the treatment group additionally received modified Guifu Dihuang Wan based on the treatment in control group, with a course of 4 weeks in both groups. Minnesota Living with Heart Failure Questionnaire (MLHFQ) total score, 6 minutes walk test (6 mWT), Seattle Angina Scale (SAQ) score, and traditional Chinese medicine(TCM) syndrome score were recorded and compared between two groups before and after treatment; their cardiac function was evaluated and adverse reactions were observed to assess the drug safety and quality of life after PCI. Result: The MLHFQ scores in treatment group after treatment were significantly lower than those before treatment and those in control groups after treatment (PPPPPConclusion: On the basis of conventional western medicine therapy, the modified Guifu Dihuang Wan can effectively improve the physical strength, mood, TCM symptoms, relieve angina pectoris, and enhance cardiac function with no adverse reactions in PCI postoperative patients. It can achieve the purpose of improving quality of life in postoperative patients, worthy of promotion.
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@#BACKGROUND: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.
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Objective • To explore the correlation of anxiety and depression with sleep quality and quality of life in elderly patients with percutaneous coronary intervention (PCI). Methods • A total of 297 elderly patients undergoing PCI were surveyed according to hospital anxiety and depression scale (HADS), Piusburgh sleep quality index (PSQI) and 12-item short form health survey version 2.0 (SF-12v2) on the day before they were discharged from two hospitals (Xinhua Hospital, Shanghai Jiao Tong University School of Medicine and Shanghai Sixth People's Hospital, Shanghai Jiao Tong University). All data was based on their subjective feelings in the past month. Spearman correlation analysis was performed on the scores of anxiety and depression to sleep quality and life quality. The multiple linear regression was used to analyze the influencing factors of life quality. Results • 21.5% of the patients were assessed as anxiety positive, and 22.2% were assessed as depression positive, both higher than those of the patients in general hospitals of China (both P=0.000). The average score of patients' sleep quality was 6.50±3.46, which was higher than the domestic norm (P=0.000). The average score of patients' quality of life was 132.20±30.83, the physiological score was 60.44±17.58, and the psychological score was 71.76±15.96. Correlation analysis showed that there was a significant positive correlation between total scores of anxiety and depression and total scores of sleep quality (P=0.026, P=0.027), and a significant negative correlation between total scores of anxiety and depression and total quality of life scores, the physiological scores and the psychological scores (all P=0.000). The linear regression equation of anxiety and depression scores and quality of life scores in elderly patients with PCI was significant (P=0.000, R2=0.246). Conclusion • The incidence of anxiety and depression in elderly PCI patients was high in the last month before admission, and the sleep was poor. The more obvious the anxiety or depression, the worse the quality of sleep and quality of life. Attention should be paid to the relations of anxiety and depression to sleep quality and quality of life, and efforts should be made to improve the negative emotions of patients and enhance their sleep quality and quality of life.
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Cardiovascular diseases have the characteristics of high morbidity and high mortality, and are recognized as the first cause of death by World Health Organization in World Health Statistics 2016. In recent years, traditional Chinese medicines have been widely applied in the treatment of cardiovascular diseases, while studies for integrated traditional Chinese and western medicines for treating cardiovascular diseases have made a great progress. Xiongshao capsule was developed by Academician Chen Keji according to classic formula Xuefu Zhuyu decoction and composed of effective parts of Rhizoma Ligusticum Wallichii and Radix Paeonia Rubra, with remarkable therapeutic effects on angina pectoris, restenosis after percutaneous coronary intervention(PCI), atherosclerosis, dyslipidemia and so on. In this review, basic and clinical studies for the effect of Xiongshao capsule in treating cardiovascular diseases were reviewed to provide reference for reasonable clinical use and example for new traditional Chinese medicine development and application under the guidance of theory of integrated traditional Chinese and western medicines.
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Aim: To report a case of huge coronary artery ectasia presenting with acute myocardial infarction; a relatively rare finding encountered during coronary angiography. Presentation of Case: A young male presented with chest pain and profuse sweating at a local hospital. Electrocardiogram showed Infero-posterior STEMI. Patient received streptokinase. His symptoms settled however the electrocardiogram changes did not resolve. He presented at our hospital after 24 hours with chest discomfort. He was vitally stable and a murmur of MR was audible. His Troponin-I was raised and electrocardiogram showed ST elevations with Q waves. Coronary angiogram showed giant ectasia and occluded right coronary artery (RCA). Percutaneous coronary intervention of RCA was done; with TIMI II flow but still had some residual thrombus. The patient was kept on Tirofiban infusion. His CRP and homocysteine levels were raised. Dual antiplatelet, statin, ACE Inhibitor, beta blocker with vitamin B12 and folic acid supplement were continued. Discussion: Coronary artery ectasia is a form of atherosclerosis seen in 0.3–4.9% of coronary angiography procedures. It is described as dilation of the coronary arteries >1.5 times compared to adjacent normal vessel. An excessive expansive remodeling with enzymatic degradation of the extracellular matrix is considered to be the major pathophysiologic process. Clinical importance inclines on its association with acute coronary syndrome. Conclusion: A case of huge coronary artery ectasia presenting with acute myocardial infarction and successfully treated with PCI.
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OBJECTIVE: To investigate the feasibility of using thromboelastogram (TEG) to guide the use of antiplatelet drugs in patients undergoing percutaneous coronary intervention (PCI). METHODS: A retrospective study was performed with 349 patients undergoing PCI from January 2011 to April 2011. According to whether measured platelet reactivity by TEG or not,patients were divided into experimental group and control group. Patients of the two groups were all given aspirin plus clopidogrel. Each group was divided into two subgroups according to the doses of antiplatelet drugs; group A used aspirin 100 mg plus clopidogrel 75 mg, and group B used aspirin 300 mg plus clopidogrel 75 mg. A 6-month follow-up was carried out to examine the incidences of bleeding and ischemic events. RESULTS: The incidences of bleeding and ischemic events in the experimental group were significantly decreased compared with those in the control group. The inhibition rates of AA and ADP were significant higher in group B than those in group A of the experimental group. CONCLUSION: Adverse events can be reduced by measuring platelet reactivity by TEG and adjusting antiplatelet drugs.
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Objective To observe the change and clinical significance of the heart type fatty acid binding protein (H-FABP) in ST Segment Elevation Myocardial Infarction (STEMI) after percutaneous coronary intervention (PCI).Methods Of 178 STEMI patients were recruited and were separated as ST segment drop group (137) and ST segment non-drop group (41).All the patients received H-FABP and cTnI tests,and re-tested H-FABP on 1 h,6 h,12 h and 24 h after the PCI,and re-tested cTnI on 12 h and 24 h after the PCI.Also,the ST segment drop amplitude (ΣSTR) was measured 2 h after the PCI.Results The demographics of both groups were similar.In both groups,the H-FABP on 6 h after PCI was significantly higher than the value measured prior to PCI.In the ST segment drop group,the H-FABP was reduced to normal value on 24 h after PCI,while it was not in the ST segment non-drop group.Conclusions The H-FABP elevation is associated with the severity of coronary lesions in ST segment elevation myocardial infarction,and the PCI may be involved in the H-FABP changes.ΣSTR≥50％ and normal HFABP may be used as index for judgment of myocardial injury and myocardial reperfusion.
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<b>Objective:</b> The purpose of this study was to evaluate the relationship between improvement of health-related quality of life (QOL) and participation in self-care activities and coronary risk factor management at 6 months after discharge for acute myocardial infarction (AMI) patients treated with percutaneous coronary intervention (PCI).<br><b>Methods:</b> A total of 118 patients were asked to complete the MOS 36-Item Short-Form Health Survey (SF-36) questionnaire at discharge and 6 months after discharge. The SF-36 consists of eight subscales: Physical Functioning (PF), Role Physical (RP), Bodily Pain (BP), General Health Perception (GH), Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH). We examined self-care activities and coronary risk factor management and related factors from SF-36 scores to measure quality of life (QOL) at discharge and 6 months after discharge.<br><b>Results:</b> The PF and BP scores at 6 months after discharge were significantly higher than those at discharge. Increasing PF and BP scores indicated improvement in ability to perform physical activities and absence of intense bodily pain that would interfere with activities of daily living or work. Improvement of PF in AMI patients treated with PCI was related to performing exercise after discharge and absence of diabetes mellitus. However, there were no related factors for BP.<br><b>Conclusion:</b> Our results indicated that exercise, as a self-care activity after discharge, for AMI patients treated with PCI may be related to the improvement of QOL.
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After its introduction by Andrew R. Gruentzig in 1977 percutaneous coronary intervention (PCI) is widely utilized in the treatment of symptomatic coronary artery disease. Though it has numerous benefits, serious and potentially life-threatening complications of PCI can occur, including iatrogenic coronary artery dissection and perforation. The incidence of these complications has been augmented by the development of coronary interventional devices intended to remove or ablate tissue. Here we review the classification, incidence, pathogenesis, clinical sequelae and management of coronary artery dissection and perforation in the current era due to PCI. Specifically, the current angiographic classifications of coronary artery dissections and perforations are reviewed. The findings of several recent, registries of PCI-related coronary artery perforations and dissection are summarized. The management of coronary artery dissection and perforation is discussed in details, including the application of newer modalities such as covered stents
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Objective To compare the efficiency and safety of clopidogrel of different loading-dose in acute coronary syndromes(ACS) patients with percutaneous coronary intervention(PCI) therapy, and, give an assessment of security about higher loading dose of clopidogrel. Methods 120 patients from January 2008 to January 2009 in our hospital were included.They were randomly divided into 3 groups(na=nb=nc=40)and were given 600 mg,450 mg and 300 mg clopidogrel on the 6 hour before PCI. There was no significant difference between the three groups' basic clinical information(p>0.05),such as age, sex and so on. Four points were selected to observe: the platelet aggregation induced by ADP with 5umol/L before and two hours、four hours, six hours after taking medicine; Primary endpoint events, which include shock during hospitalization, death, target revascularization, myocardial infarction, recurrent angina, stroke in 30 days,and Postoperative Bleeding events and adverse Reactions after Surgery in 30 days. Results compared to the standard dose of 300 mg clopidogrel, 600 mg doses clopidogrel can give a greater degree of inhibition on platelet activating than 450 mg doses in the pre-6 h after administration. Increase Clopidogrel loading dose can reduce the occurrence of major cardiovascular events rate. Bleeding events and the occurrence of adverse events was no significant difference among three groups. Conclusions compared to the standard dose of 300 mg clopidogrel, a higher loading dose of clopidogrel can produce much more faster, greater platelet inhibition, and similar security.
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@#Objective To investigate left ventricular systolic function with mitral annulus motion velocity(Sa) with pulsed-wave Doppler tissue imaging(PW-DTI) in patients with coronary arteriosclerosis disease(CAD) after percutaneous coronary intervention(PCI).Methods 52 patients with CAD,who were determined by coronary artery angiography,were divided into two groups,PCI group(n=33) and non-PCI group(n=19).They were followed up with PW-DTI and conventional echocardiography before and 5 d,3 months and 6 months after intervention in PCI ones,before and 6 months after angiography in non-PCI ones.In PCI group,the patients were divided two subgroups: EF≥50% and EF=30%～50%.Results The Sa improved significantly in PCI group 6 months after intervention(P<0.001).EF correlated with Sa(r=0.705,r=0.770 pre-and post-intervention respectively,P<0.0001).Conclusion Sa can be used to evaluate left ventricular systolic function of CAD patients.
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@# A general situation on research about the endothelins (ET) such as its synthesis, secretion and the mitogenic activity on vascular smooth muscle cells (VSMC), and its effect on restenosis after percutaneous coronary intervention (PCI) was reviewed by the authors.
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OBJECTIVE:To observe the adjunctive efficacy of allicin for restenosis of geriatric myocardial infarction (MI) after percutaneous coronary intervention (PCI). METHODS:From Jan.to Dec.2007,150 geriatric MI patients after PCI were divided into 2 groups (n=75 each),i.e. conventional therapy group and allicin group (allicin 40 mg tid plus conventional therapy). After treatment for 1 year,plasma levels of restenosis markers including endothelin-1,CRP,NO were tested; Coronary arteriography was carried out to reveal the restenosis situation; Angina attack frequencies were also recorded. RESULTS:66 cases in allicin group vs.57 in conventional therapy group had no recurrence of angina,with the effective rate being 88% in allicin group vs.76% in conventional therapy group,showing significant differences between the two groups (P
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Objective To investigate clinical treatment status in early hospitalized patients with acute ST-segment elevated myocardial infarction(STEMI).Methods The data of hospitalized patients with STEMI admitted between January 2001 and June 2005 were retrospectively collected and studied from medical records of the 2nd Hospital of Tianjin Medical University.Results A total of 773 cases were investigated,71.80% of the patients were male,the median age was 66.0 years,and the hospitalization duration was 11.0 days.The median duration from the onset of STEMI to the arrival in the wards was 210 min.The median initiation time of door-to-needle or door-to-balloon treatment for reperfusion therapy was 60 and 100 minutes,respectively.As to the selection of the reperfusion strategies,patients who were male,younger(age
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0.05).(2)The plasma GMP-140 levels of both groups was remarkably increased immediately and a decreased trend 24 h after PCI,but did not return to normal(P
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OBJECTIVE:To study the effect of percutaneous coronary intervention(PCI)and vein thrombolytic therapy on QT dispersion(QTd)after early recanalization of the infracted related artery(IRA)in order to provide the scientific reference for the comprehensive measures against acute ST-segment elevation after myocardial infarction(STEMI).METHODS:117patients with STEMI were selected within12hours after the onset,and then randomly divided into PCI group(56patients)and vein thrombolytic therapy group(61patients).QTd were determined before and24h after treatment.RESULTS:The recanal-ization rates in PCI and vein thrombolytic therapy group were100%and73.8%,respectively(P
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Objective To discuss the reasons of death in the in-patients with percutaneous coronary intervention(PCI).Methods Retrospective analysis was done in 33 cases who died in or after the procedures among 3 252 in-patients with PCI.Results 4 patients died in procedures and the others died after procedures.The major reasons of death in order were:cardiogenic shock,ventricular fibrillation,acute left heart failure,multiple organ failure,heart rupture and acute renal failure.The in-hospital mortality rate was 1.01%.Conclusion The major reasons of death of patients with PCI are cardiogenic shock,ventricular fibrillation and acute left heart failure.Taking some measures will reduce the in-hospital mortality rate.