目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NG...目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、术后TIMI分级、TIMI记帧、和心肌blush分级以及术后一周内及3个月后左室射血分数(LVEF)。结果:两组全部病例均成功地置入支架,GW组全部成功放置GuardWire PlusTM保护装置,GW组ST段回落□50%的百分比明显高于NGW组(68．4%vs41．2%,p＜0．05)。术后TIMI分级两组没有明显差别,TIMI记帧(p=0．043)和心肌blush分级有明显差别(p=0．000)。GW组的左室射血分数(LVEF)明显高于NGW组。结论:急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。展开更多
The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,p...The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GP Ⅱ/Ⅲ or direct thrombectomy can＇t improve short or long-term clinical outcomes, So we evaluated the safety and efficacy of distal protection device （GuardWire PlusTM） in the acute myocardial in farction （AMI） combined with percutaneous coronary intervention （PCI）. Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group （GW group） and non-distal protection group（NGW） group. Data analyzed between the two groups were included the clinical characteristics, angiographic results, ST segment resolution, postoperative TIMI flow grade, TIMI frame count, myocardial blush grade, the left ventricular ejection fraction （LVEF） by eehocardiography in a Week after or 3 months after PCI, myocardial enzymes,preoperative and postoperative neuroendoerine biomarkers： endothelin （ET）, plasma renin activity （PRA）, angiotensin Ⅱ （AII）, aldosterone（ALD）, norepinephrine（NE）, epinephrine （E）. Results ST segment resolution ≥ 50% was significantly higher in the GW group （68.4%） than in NGW group （41.2%, P 〈 0.05）. Early peak CK-MB and CTNI in GW group versus NGW group （8.63 ±2.42 hours vs 11.18 ±2.26 hours,10.16 ±2.96 hours vs 12.35 ±2.06 hours）, and peak reduction difference were observed （63.3 ±9.82 vs 74.28 ＋ 6.15 P = 0.000, 18.01 ＋ 7.21 vs 21.48 ±5.61 P = 0.027）. Left ventricular ejection fraction （LVEF） was higher in GW group （P = 0.01） than in NGW group. TIMI grade exhibited no difference while TIMI frame count （P = 0.043） and myocardial blush grade were significantly different （P = 0.0001）. Postoperative biomarkers in endocrine expression were higher significantly in NGR group （P 〈 0.05）. Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism, reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.展开更多
Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-...Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.展开更多
文摘目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、术后TIMI分级、TIMI记帧、和心肌blush分级以及术后一周内及3个月后左室射血分数(LVEF)。结果:两组全部病例均成功地置入支架,GW组全部成功放置GuardWire PlusTM保护装置,GW组ST段回落□50%的百分比明显高于NGW组(68．4%vs41．2%,p＜0．05)。术后TIMI分级两组没有明显差别,TIMI记帧(p=0．043)和心肌blush分级有明显差别(p=0．000)。GW组的左室射血分数(LVEF)明显高于NGW组。结论:急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。
文摘The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GP Ⅱ/Ⅲ or direct thrombectomy can＇t improve short or long-term clinical outcomes, So we evaluated the safety and efficacy of distal protection device （GuardWire PlusTM） in the acute myocardial in farction （AMI） combined with percutaneous coronary intervention （PCI）. Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group （GW group） and non-distal protection group（NGW） group. Data analyzed between the two groups were included the clinical characteristics, angiographic results, ST segment resolution, postoperative TIMI flow grade, TIMI frame count, myocardial blush grade, the left ventricular ejection fraction （LVEF） by eehocardiography in a Week after or 3 months after PCI, myocardial enzymes,preoperative and postoperative neuroendoerine biomarkers： endothelin （ET）, plasma renin activity （PRA）, angiotensin Ⅱ （AII）, aldosterone（ALD）, norepinephrine（NE）, epinephrine （E）. Results ST segment resolution ≥ 50% was significantly higher in the GW group （68.4%） than in NGW group （41.2%, P 〈 0.05）. Early peak CK-MB and CTNI in GW group versus NGW group （8.63 ±2.42 hours vs 11.18 ±2.26 hours,10.16 ±2.96 hours vs 12.35 ±2.06 hours）, and peak reduction difference were observed （63.3 ±9.82 vs 74.28 ＋ 6.15 P = 0.000, 18.01 ＋ 7.21 vs 21.48 ±5.61 P = 0.027）. Left ventricular ejection fraction （LVEF） was higher in GW group （P = 0.01） than in NGW group. TIMI grade exhibited no difference while TIMI frame count （P = 0.043） and myocardial blush grade were significantly different （P = 0.0001）. Postoperative biomarkers in endocrine expression were higher significantly in NGR group （P 〈 0.05）. Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism, reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.
文摘Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.
