Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients w...Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.[S Chin J Cardiol 2019;20(3):140-145]展开更多
Background Short-term hospital readmissions after percutaneous coronary intervention （PCI） account for higher medical costs and poor prognosis of patients with coronary artery disease （CAD）. However, patients at h...Background Short-term hospital readmissions after percutaneous coronary intervention （PCI） account for higher medical costs and poor prognosis of patients with coronary artery disease （CAD）. However, patients at high risk for readmission are not yet identified. Methods A total of 1416 patients successfully treated with PCI were included. Data of age, sex, presentation type of CAD, cardiac function, coexistent diseases, con- trast dose, numbers of lesions and stents implanted, procedure complication, out-of-hospital medication were collected. Cox regression model was employed to analyze the multiple factors influencing readmission. Results 75.8% of all readmissions were due to CAD and the average readmission time was 422 days. Univariate analysis and multivariate Cox regression model eventually showed that patients with any procedure complica- tions and/or more lesions in number were at higher risk for readmission while older age, smoke, urgent PCI and more stents implanted prevented them from readmitting. Conclusion The major cause of readmission af- ter PCI is still CAD itself. During the index hospitalization of PCI, patients with multi-vessel disease need careful treatment and procedure complications should be prevented in order to extend the interval of readmis-sion.展开更多
基金supported by the National Natural Science Fund(No.81602848)
文摘Background Rupture of descending thoracic aorta is a rare but lethal disease. Compared with open surgery,thoracic endovascular aortic repair(TEVAR)becomes a less invasive procedure in emergent management of patients with feasible anatomy. Nevertheless,mortality remains high as well as morbidity despite successful operation. The purpose of this study was to compare TEVAR with conservative therapy on the 30-day mortality of patients with ruptured descending thoracic aorta. Methods Retrospective analysis of patients admitted to our hospital with descending thoracic aortic rupture was performed. Patients presented with rupture of descending thoracic aorta with feasible anatomy for TEVAR between Jan 2014 and June 2019 were included. Patients were divided into operative and conservative group depending on which therapy they received. Patients received TEVAR were defined as the operative group,while those received conservative therapy were defined as conservative treatment group. Results There were twenty-six patients in total,including fifteen aortic dissections,nine were thoracic aneurysms,and two were traumatic injuries. Theie mean age was 60±13 years with only two female. Seven patients(27%)presented with shock and twenty-two(85%)was accompanied with hemothorax on admission. Nineteen patients(73%)accepted emergent TEVAR with 100% primary technical success,and the other seven received conservative treatment. In operative group,infection(89%)and respiratory failure(63%)occurred after TEVAR. The in-hospital mortality for operative and conservative treatment group was 26% and 57% respectively(P=0.18). Operative group had lower 30-day mortality(26% vs. 86%,P=0.021). Conclusions TEVAR is associated with improved early outcome in patients with ruptured descending thoracic aorta.[S Chin J Cardiol 2019;20(3):140-145]
基金supported by 2010Guangdong Provincial Sci-tech Program(No:2010b31600163)
文摘Background Short-term hospital readmissions after percutaneous coronary intervention （PCI） account for higher medical costs and poor prognosis of patients with coronary artery disease （CAD）. However, patients at high risk for readmission are not yet identified. Methods A total of 1416 patients successfully treated with PCI were included. Data of age, sex, presentation type of CAD, cardiac function, coexistent diseases, con- trast dose, numbers of lesions and stents implanted, procedure complication, out-of-hospital medication were collected. Cox regression model was employed to analyze the multiple factors influencing readmission. Results 75.8% of all readmissions were due to CAD and the average readmission time was 422 days. Univariate analysis and multivariate Cox regression model eventually showed that patients with any procedure complica- tions and/or more lesions in number were at higher risk for readmission while older age, smoke, urgent PCI and more stents implanted prevented them from readmitting. Conclusion The major cause of readmission af- ter PCI is still CAD itself. During the index hospitalization of PCI, patients with multi-vessel disease need careful treatment and procedure complications should be prevented in order to extend the interval of readmis-sion.
