直接血管成形术中行冠状动脉内血栓抽吸切除术对ST段抬高型前壁心肌梗死患者左室重构的影响

Objective: To evaluate prospectively the impact on left ventricular(LV) remodelling of an intracoronary aspiration thrombectomy device as adjunctive therapy in primary percutaneous coronary intervention(PCI) in patients with anterior ST elevation myocardial infarction(STEMI). Methods: 76 consecutive patients with anterior STEMI(65.3(11.2) years, 48 men) were randomly assigned to intracoronary thrombectomy and stent placement(n=38) or to conventional stenting(n=38) of the infarct related artery. Each patient underwent transthoracic echocardiography immediately after PCI and at six months. At the time of echocardiographic control, major adverse cardiovascular events(MACE) in terms of death, new onset of myocardial infarction, and hospitalisation for heart failure were also evaluated. Results: After a successful primary PCI, patients in the thrombectomy group achieved a higher rate of post-procedure myocardial blush grade 3(36.8%v 13.1%, p=0.03) and effective ST segment resolution at 90 minutes(81.6%v 55.3%, p=0.02). Six months after the index intervention, 19 patients(26.8%) developed LV dilatation, defined as an increase in end diastolic volume(EDV) ≥20%: 15 in the conventional group and four in the thrombectomy group(p=0.006). Accordingly, at six months patients treated conventionally had significantly higher end systolic volumes(82(7.7) ml v 75.3(4.9) ml, p< 0.0001) and EDV(152.5(18.1) ml v 138.1(10.7) ml, p< 0.0001) than patients treated with thrombectomy. No differences in cumulative MACE were observed(10.5%in the conventional group v 8.6%in the thrombectomy group, not significant). Conclusion: Compared with conventional stenting, adjunctive aspiration thrombectomy in successful primary PCI seems to be associated with a significantly lower incidence of LV remodelling at six months in patients with anterior STEMI.

西罗莫司与紫杉醇药物洗脱支架在T细胞亚群再分布方面作用的比较

We sought to investigate the effects of 2 different coronary drug- eluting stents on the distribution of central or effector memory T cells circulating in the coronary sinus of patients with coronary artery disease who underwent percutaneous coronary revascularization. We randomly assigned 43 patients(mean age 65.4± 4.3 years; 34 men) presenting with stable coronary disease and angiographically proved stenosis of the left anterior descending artery to treatment with sirolimus- or paclitaxel- eluting stents. Heparinized blood samples were obtained from the coronary sinus before and 20 minutes after stent implantation. Analysis of surface phenotype was performed by 4- color flow cytometry, and data are expressed as the percentage of positive cells. The percentages of CD8+ and CD4+ effector memory T cells, as defined by the CD3+ CD45RO+ CD27- phenotype, were significantly reduced in patients who received a sirolimus- eluting stent compared with the basal values. Conversely, the percentages of CD8+ , but not CD4+ , central memory T cells(CD3+ CD45RO+ CD27+ ) were increased in the same treatment group after the revascularization procedure. No changes in the percentages of memory T- cell populations in the paclitaxel- eluting stent group were observed. These findings show that sirolimus- eluting stents rapidly induced a redistribution of memory T lymphocytes, with a significant decrease of proinflammatory effector memory T cells circulating within the coronary sinus.

可拆卸圈套器和注射肾上腺素预防息肉切除术后出血的比较:一项随机对照试验

Background and Study Aims: Several endoscopic techniques have been developed t o prevent bleeding after the removal of large pedunculated polyps. Patients and Methods: From January 1995 to December 2002, 488 consecutive patients with pedun culated colorectal polyps, the heads of which were larger than 10 mm in diameter , were randomly assigned to three groups. In group A (163 patients), detachable snares were placed at the base of the stalk and standard snares were then used f or polypectomy. In group B (161 patients), the polyp stalk was injected with a 0 .01%epinephrine solution before conventional snare polypectomy. Group C (a cont rol group including 164 patients) underwent conventional snare polypectomy witho ut preventive measures. Early (< 24 h) and late (> 24 h-30 days) bleeding compl ications were assessed. Each group was divided into two subgroups relative to th e polyp size (polyps 1.0-1.9 cm and polyps ≥2 cm). Results: Overall bleeding c omplications occurred after 4.3%of the polypectomies. Bleeding was successfully controlled in all patients, and no blood transfusions were required. There were three cases of bleeding in group A (1.8%), five in group B (3.1%), and 13 in group C (7.9%). Early bleeding was more frequent than late bleeding (15 vs. six patients). In polyps ≥2 cm (207 patients), postpolypectomy bleeding occurred i n 14 patients (6.7%): two (2.7%) in the detachable snare group, two (2.9%) in the epinephrine injection group, and 10 (15.1%) in the control group. Conclusi ons: These results show that polypectomy of large pedunculated polyps is associa ted with a higher incidence of bleeding. Particularly in polyps larger than 2 cm , preventive measures can significantly reduce bleeding complications after poly pectomy. This can be achieved with similar efficacy either by placing Endoloops or by injecting epinephrine.