急性亚急性Stanford B型主动脉夹层患者胸主动脉远段置入覆膜支架疗效与安全性分析

目的探讨急性亚急性Stanford B型主动脉夹层(TBAD)患者胸主动脉远段置入覆膜支架的疗效与安全性。方法选取北部战区总医院自2002年6月至2022年6月收治的588例行胸主动脉腔内修复术(TEVAR)的TBAD患者为研究对象。根据置入覆膜支架近端是否位于4区,将患者分为远段组(n=43)与近段组(n=545)。比较两组患者的基线资料与1、5年内的不良事件发生率。采用Kaplan-Meier曲线比较两组患者5年内支架移植物远端新发破口(dSINE)的发生率。结果匹配前,远段组患者年龄高于近段组,男性比例、住院期间使用钙离子拮抗剂比例、血红蛋白、白细胞计数均低于近段组,差异均有统计学意义(P<0.05);匹配后,两组患者各项基线资料比较,差异均无统计学意义(P>0.05)。匹配前,远段组患者1年内dSINE发生率高于近段组,差异有统计学意义(P<0.05);匹配后,远段组患者1年内主动脉相关不良事件、dSINE发生率均高于近段组,差异均有统计学意义(P<0.05)。Kaplan-Meier分析结果显示:匹配前、匹配后,远段组1年内dSINE发生率均高于近段组,差异均有统计学意义(P<0.05)。结论置入覆膜支架位于4区的TBAD患者接受TEVAR后1年内dSINE发生率较高,应予以重视并加强近期随访。

体质量指数对急性主动脉综合征患者腔内修复术临床疗效影响

目的探讨体质量指数(BMI)对急性主动脉综合征(AAS)患者腔内修复术(TEVAR)临床疗效的影响。方法选取自2002年4月至2022年1月于北部战区总医院行TEVAR的951例AAS患者为研究对象,最终719例患者入选本研究。根据BMI是否≥24.0 kg/m^(2)将患者分为正常BMI组(BMI 18.5~23.9 kg/m^(2),n=192)与高BMI组(BMI≥24.0 kg/m^(2),n=527)。观察两组患者术后1个月、术后5年内的临床不良事件发生情况。结果术后1个月内高BMI组患者感染性疾病发生率、伤口脂肪液化发生率、总不良事件发生率高于正常BMI组,差异有统计学意义(P均<0.05)。两组脂肪液化患者住院时间均长于非脂肪液化患者,差异均有统计学意义(P均<0.05)。两组患者术后5年(新发)全因死亡发生率、新发脑卒中发生率、主动脉相关不良事件发生率、总不良事件发生率及再次行TEVAR发生率比较,差异均无统计学意义(P均>0.05)。结论BMI升高与AAS行TEVAR患者伤口脂肪液化及感染性疾病发生率增加有关,患者住院时间延长,增加了心理及经济负担,但其对远期临床不良事件发生率无明显影响。

Application of N-terminal pro-brain natriuretic peptide concentration and the Global Registry of Acute Coronary Events risk score to predict major adverse cardiac events in patients with ST-elevation myocardial infarction after PCI

Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain natriuretic peptide(NT-pro-BNP)concentration and global acute coronary event register(GRACE)risk score in the prognosis of ST-segment elevation myocardial infarction(STEMI)patients,to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of STEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 118 confirmed STEMI patients who had received acute percutaneous coronary intervention(PCI).Thirty patients with STEMI were included in the major cardiac adverse events(MACEs)group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).The linear correlation analysis confirmed the relationship between NT-proBNP concentration and GRACE score.Results After adjustment for sex,history of current smoking,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that NT-proBNP concentration and GRACE score were the independent predictors for MACEs in STEMI patients who received PCI.Linear regression analysis showed that the level of NT-pro-BNP was positively correlated with GRACE score(r=0.612,P=0.000).The area under the curve(AUC)for GRACE,NT-pro-BNP and their combination were 0.757,0.723 and 0.782,respectively.Conclusions In a one-year follow-up,the concentration of NTpro-BNP and GRACE score were valuable of prediction for MACEs in STEMI patients who received PCI.In addition,NT-pro-BNP concentration was positively correlated with GRACE score.Additionally,the concentration of NT-pro-BNP could moderately enhance the GRACE score prediction of 1-year MACEs in STEMI patients who received PCI.

左前降支病变合并邻近心肌桥支架治疗远期疗效分析

目的探讨应用冠状动脉定量造影(QCA)分析并评价左前降支(LAD)合并邻近心肌桥(MB)支架治疗的远期临床疗效。方法选取自2007年12月至2017年6月北部战区总医院收治的行QCA发现LAD合并邻近MB的63例患者为研究对象。主要终点:24个月的主要心血管不良事件(MACE),包括心源性死亡、非致死性心肌梗死、靶血管血运重建(TVR)。次要终点:24个月的患者源性的复合终点事件(PoCE),包括全因死亡、非致死性心肌梗死、血运重建、心绞痛再发、因心力衰竭再次住院、恶性心律失常、出血学术研究联合会(BARC)出血分级≥2级。采用Cox回归分析分析术后24个月患者发生PoCE的独立危险因素。结果主要终点:术后24个月发生MACE 2例(3.2%),其中心源性死亡1例(1.6%)、非致死性心肌梗死0例(0)、TVR 1例(1.6%)。次要终点:术后24个月发生PoCE 27例(42.9%),包括全因死亡1例(1.6%)、非致死性心肌梗死0例(0)、因心力衰竭再次住院0例(0)、恶性心律失常0例(0)、血运重建5例(7.9%)、心绞痛再发20例(31.7%)、BARC出血分级≥2级1例(1.6%)。Cox回归分析发现,男性、血脂异常为24个月发生PoCE的独立危险因素(P<0.05)。结论在严格掌握适应证及精确定位情况下,植入支架治疗LAD病变合并邻近MB患者,可取得较好的长期临床疗效。男性、血脂异常是支架植入术后不良事件发生的危险因素。