目的探讨高龄老年冠心病患者行冠状动脉介入治疗(PCI)的临床特点和远期预后。方法连续纳入于2013年1—12月行PCI治疗的老年冠心病患者2981例,比较其中普通老年患者(65~74岁, n =2300,普通组)与高龄老年患者(≥75岁, n =681,高龄组)的临...目的探讨高龄老年冠心病患者行冠状动脉介入治疗(PCI)的临床特点和远期预后。方法连续纳入于2013年1—12月行PCI治疗的老年冠心病患者2981例,比较其中普通老年患者(65~74岁, n =2300,普通组)与高龄老年患者(≥75岁, n =681,高龄组)的临床特点及PCI术后2年随访期间的临床预后情况。结果高龄组BMI、左室射血分数(LVEF)、术前肾小球滤过率(eGFR)、使用钙离子拮抗剂等以及冠状介入情况(经桡动脉途径等)的比例较普通组低( P <0.05);既往PCI史、使用质子泵抑制剂等的比例以及冠状动脉病变情况(左主干病变、右冠状动脉病变、术前SYNTAX评分、严重钙化病变等)较普通组高( P <0.05)。2年随访结果显示,高龄组全因死亡、心源性死亡以及支架内血栓的发生率明显高于普通组( P <0.05);主要不良心脑血管事件、再发心肌梗死、血运重建(靶血管和靶病变血运重建)、脑卒中、出血以及大出血的发生率比较,2组差异无统计学意义( P >0.05)。高龄组中,女性全因死亡、心源性死亡以及再发心肌梗死的发生率明显高于男性( P <0.05)。单因素和多因素COX回归分析显示,术后2年随访期间,年龄是老年冠心病患者发生支架内血栓的独立危险因素( P <0.05),不是全因死亡以及心源性死亡的独立危险因素( P >0.05);既往脑血管病史是全因死亡的独立危险因素( P <0.05);使用主动脉内球囊反搏(IABP)、较好的心肾功能、经桡动脉途径是全因死亡以及心源性死亡的独立保护因素( P <0.05);女性是高龄患者全因死亡的独立危险因素( P <0.05),不是心源性死亡和再发心肌梗死的独立危险因素( P > 0.05)。结论高龄老年冠心病患者合并较差的心肾功能以及程度较重的冠状动脉病变。PCI术后2年随访期间:1)全因死亡、心源性死亡以及支架内血栓的发生率较高。2)经校正多种危险因素后,年龄不是老年冠心病患者全因死亡以及心源性死亡的独立危险因素,而是支架内血栓的独立危险因素;女性是高龄老年冠心病患者全因死亡的独立危险因素,不是心源性死亡和再发心肌梗死的独立危险因素。展开更多
目的:探讨过渡性经皮球囊主动脉瓣成形术(PBAV)治疗危重主动脉瓣狭窄患者的临床应用经验。方法:回顾性分析2011-03至2017-03在阜外医院行PBAV的37例暂不适宜行瓣膜置换术的危重主动脉瓣狭窄患者,年龄(74±12)岁。观察患者临床及解...目的:探讨过渡性经皮球囊主动脉瓣成形术(PBAV)治疗危重主动脉瓣狭窄患者的临床应用经验。方法:回顾性分析2011-03至2017-03在阜外医院行PBAV的37例暂不适宜行瓣膜置换术的危重主动脉瓣狭窄患者,年龄(74±12)岁。观察患者临床及解剖特点、手术有效及安全性,并进行随访。结果:本组患者基线外科风险高心功能差,二叶式主动脉瓣占比约50%,瓣叶钙化程度重[钙化体积CT值850(HU850)=(856.0±658.2)mm3]。术中参考瓣环上平均内径选择球囊,术后7天主动脉瓣瓣口面积从(0.37±0.10)cm2增大至(0.87±1.10)cm2,主动脉瓣平均跨瓣压差从(55.1±22.9)mm Hg(1 mm Hg=0.133 k Pa)降至(44.8±17.8)mm Hg(P<0.001),左心室射血分数从(35.8±14.3)%增加到(41.0±12.2)%(P<0.001)。术后住院期间发生死亡4例,1例安装永久起搏器,1例主动脉瓣重度反流。术后平均随访(16.5±11.1)个月,共有13例(35.1%)患者过渡到外科或经导管瓣膜置换术治疗。结论:对于暂不宜行外科主动脉瓣置换术和经导管主动脉瓣置换术(TAVR)的危重主动脉瓣狭窄患者,PBAV可取得良好的早期临床结果,有望成为过渡性治疗手段,对于中国二叶式主动脉瓣比例高,瓣叶钙化重特点,采用瓣环上内径选择较小球囊安全有效。展开更多
目的:分析20世纪70年代(以下简称1970s)和21世纪10年代(以下简称2010s)近40年,北京地区急性心肌梗死(AMI)患者人口学特征、危险因素和诱发因素的变化情况。方法:1970s组数据来源于北京地区防治冠心病协作组于1972-01至1973-12间登记的1 ...目的:分析20世纪70年代(以下简称1970s)和21世纪10年代(以下简称2010s)近40年,北京地区急性心肌梗死(AMI)患者人口学特征、危险因素和诱发因素的变化情况。方法:1970s组数据来源于北京地区防治冠心病协作组于1972-01至1973-12间登记的1 314例AMI患者,2010s组数据来源于中国AMI注册登记(CAMI)研究2013-01-01至2014-09-30期间北京地区入选的2 200例AMI患者。比较两组患者的人口学特征(包括性别、年龄和农民比例)、危险因素和诱发因素方面差异。结果:与1970s组相比,2010s组AMI患者中>70岁患者比例(15.8 %vs 25.6%,P<0.001)、男性比例(68.3% vs75.6%,P<0.001)和农民比例(6.5%vs 14.5%,P<0.001)均增加。与1970s组相比,2010s组AMI患者中既往卒中史(6.2% vs 10.5%,P<0.001)、既往心肌梗死史(9.5% vs 11.9%,P<0.05)及合并糖尿病比例(6.2% vs 27.6%,P<0.001)明显升高。与1970s组相比,2010s组由于精神应激的AMI患者比例降低(51.1% vs 15.2%,P<0.001)、体力应激诱发的AMI患者比例增高(40.0% vs 61.1%,P=0.007)。结论:近40年,北京地区AMI患者的年龄、性别、农民比例,卒中史、心肌梗死史及糖尿病患者比例发生了巨大的变化,呈现老龄化、男性化、农村化的趋势,体力应激和不良的生活方式是当代AMI的主要诱发因素。对此变化趋势应开展更有针对性的心脏病预防和教育项目。展开更多
Background No-reflow after emergency percutaneous coronary intervention （PCI） for acute ST segment elevation myocardial infarction （STEMI） is related to the severe prognosis. The aim of this study was to evaluate ...Background No-reflow after emergency percutaneous coronary intervention （PCI） for acute ST segment elevation myocardial infarction （STEMI） is related to the severe prognosis. The aim of this study was to evaluate the efficacy of Tongxinluo, a traditional Chinese medicine, on no-reflow and the infarction area after emergency PCI for STEMI.Methods A total of 219 patients （female 31, 14%） undergoing emergency PCI for STEMI from nine clinical centers were consecutively enrolled in this randomized, double-blind, placebo-controlled, multicenter clinical trial from January 2007 to May 2009. All patients were randomly divided into Tongxinluo group （n=108） and control group （n=111）, given Tongxinluo or placebo in loading dose 2.08 g respectively before emergency PCI with asprin 300 mg and clopidogrel 300 mg together, then 1.04 g three times daily for six months after PCI. The ST segment elevation was recorded by electrocardiogram at hospitalization and 1, 2, 6, 12, 24 hours after coronary balloon dilation to evaluate the myocardial no-flow; myocardial perfusion scores of 17 segments were evaluated on day 7 and day 180 after STEMI with static single-photon emission computed tomography （SPECT） to determine the infarct area.Results There was no statistical significance in sex, age, past history, chest pain, onset-to-reperfusion time, Killip classification, TIMI flow grade just before and after PCI, either in the medication treatment during the follow up such as statin, β-blocker, angiotensin converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） between two groups. There was significant ST segment restoration in Tongxinluo group compared to the control group at 6 hours （（-0.22±0.18） mV vs. （-0.18±0.16） mV, P=0.0394）, 12 hours （（-0.24 ± 0.18） mV vs. （-0.18±0.15） mV, P=0.0158） and 24 hours （（-0.27±0.16） mV vs. （-0.20±0.16） mV, P=0.0021） reperfusion; and the incidence of myocardial no-reflow was also reduced significantly at 24-hour reperfusion （34.3% vs. 54.1%, P=0.0031）. The myocardial perfusion scores of 17 segments evaluated by static SPECT was improved significantly on day 7 and day 180 after STEMI in Tongxinluo group compared to the control group （0.61±0.40 vs. 0.76±0.42, P=0.0109 and 0.51 ±0.42 vs. 0.66±0.43, P=0.0115, respectively）.There was no significant difference in severe adverse events between two groups.Conclusion Tongxinluo as a kind of traditional Chinese medicine could reduce myocardial no-reflow and infarction area significantly after emergency PCl for STEMI with conventional medicine therapy.展开更多
Background The traditional Chinese medicine injury, but the mechanism of its action is not we protective role of Tongxinluo. Tongxinluo can protect myocardium against documented. We examined the involvement schaemia/r...Background The traditional Chinese medicine injury, but the mechanism of its action is not we protective role of Tongxinluo. Tongxinluo can protect myocardium against documented. We examined the involvement schaemia/reperfusion of nitric oxide in the Methods Miniswine were randomized to four groups of seven： sham, control, Tongxinluo and Tongxinluo coadministration with a nitric oxide synthase inhibitor N^ωnitro-L-arginine （L-NNA, 10 mg/kg i.v.）. Three hours after administration of Tongxinluo, the animals were anaesthetised and the left anterior descending coronary artery ligated and maintained in situ for 90 minutes followed by 3 hours of reperfusion before death. Area of no reflow and necrosis and risk region were determined pathologically by planimetry. The degree of neutrophil accumulation in myocardium was obtained by measuring myeloperoxidase activity and histological analysis. Myocardial endothelial nitric oxide synthase activity and vascular endothelial cadherin content were measured by colorimetric method and immunoblotting analysis respectively. Results Tongxinluo significantly increased the local blood flow and limited the infarct and size of no reflow. Tongxinluo also attenuated myeloperoxidase activity and neutrophil accumulation in histological sections and maintained the level of vascular endothelial cadherin and endothelial nitric oxide synthase activity in the reflow region when compared with control group. The protection of Tongxinluo was counteracted by coadministration with L-NNA. Conclusions Tongxinluo may limit myocardial ischaemia and protect the heart against reperfusion injury. Tongxinluo regulates synthesis of nitric oxide by altering activity of endothelial nitric oxide synthase.展开更多
文摘目的探讨高龄老年冠心病患者行冠状动脉介入治疗(PCI)的临床特点和远期预后。方法连续纳入于2013年1—12月行PCI治疗的老年冠心病患者2981例,比较其中普通老年患者(65~74岁, n =2300,普通组)与高龄老年患者(≥75岁, n =681,高龄组)的临床特点及PCI术后2年随访期间的临床预后情况。结果高龄组BMI、左室射血分数(LVEF)、术前肾小球滤过率(eGFR)、使用钙离子拮抗剂等以及冠状介入情况(经桡动脉途径等)的比例较普通组低( P <0.05);既往PCI史、使用质子泵抑制剂等的比例以及冠状动脉病变情况(左主干病变、右冠状动脉病变、术前SYNTAX评分、严重钙化病变等)较普通组高( P <0.05)。2年随访结果显示,高龄组全因死亡、心源性死亡以及支架内血栓的发生率明显高于普通组( P <0.05);主要不良心脑血管事件、再发心肌梗死、血运重建(靶血管和靶病变血运重建)、脑卒中、出血以及大出血的发生率比较,2组差异无统计学意义( P >0.05)。高龄组中,女性全因死亡、心源性死亡以及再发心肌梗死的发生率明显高于男性( P <0.05)。单因素和多因素COX回归分析显示,术后2年随访期间,年龄是老年冠心病患者发生支架内血栓的独立危险因素( P <0.05),不是全因死亡以及心源性死亡的独立危险因素( P >0.05);既往脑血管病史是全因死亡的独立危险因素( P <0.05);使用主动脉内球囊反搏(IABP)、较好的心肾功能、经桡动脉途径是全因死亡以及心源性死亡的独立保护因素( P <0.05);女性是高龄患者全因死亡的独立危险因素( P <0.05),不是心源性死亡和再发心肌梗死的独立危险因素( P > 0.05)。结论高龄老年冠心病患者合并较差的心肾功能以及程度较重的冠状动脉病变。PCI术后2年随访期间:1)全因死亡、心源性死亡以及支架内血栓的发生率较高。2)经校正多种危险因素后,年龄不是老年冠心病患者全因死亡以及心源性死亡的独立危险因素,而是支架内血栓的独立危险因素;女性是高龄老年冠心病患者全因死亡的独立危险因素,不是心源性死亡和再发心肌梗死的独立危险因素。
文摘目的:探讨过渡性经皮球囊主动脉瓣成形术(PBAV)治疗危重主动脉瓣狭窄患者的临床应用经验。方法:回顾性分析2011-03至2017-03在阜外医院行PBAV的37例暂不适宜行瓣膜置换术的危重主动脉瓣狭窄患者,年龄(74±12)岁。观察患者临床及解剖特点、手术有效及安全性,并进行随访。结果:本组患者基线外科风险高心功能差,二叶式主动脉瓣占比约50%,瓣叶钙化程度重[钙化体积CT值850(HU850)=(856.0±658.2)mm3]。术中参考瓣环上平均内径选择球囊,术后7天主动脉瓣瓣口面积从(0.37±0.10)cm2增大至(0.87±1.10)cm2,主动脉瓣平均跨瓣压差从(55.1±22.9)mm Hg(1 mm Hg=0.133 k Pa)降至(44.8±17.8)mm Hg(P<0.001),左心室射血分数从(35.8±14.3)%增加到(41.0±12.2)%(P<0.001)。术后住院期间发生死亡4例,1例安装永久起搏器,1例主动脉瓣重度反流。术后平均随访(16.5±11.1)个月,共有13例(35.1%)患者过渡到外科或经导管瓣膜置换术治疗。结论:对于暂不宜行外科主动脉瓣置换术和经导管主动脉瓣置换术(TAVR)的危重主动脉瓣狭窄患者,PBAV可取得良好的早期临床结果,有望成为过渡性治疗手段,对于中国二叶式主动脉瓣比例高,瓣叶钙化重特点,采用瓣环上内径选择较小球囊安全有效。
文摘目的:分析20世纪70年代(以下简称1970s)和21世纪10年代(以下简称2010s)近40年,北京地区急性心肌梗死(AMI)患者人口学特征、危险因素和诱发因素的变化情况。方法:1970s组数据来源于北京地区防治冠心病协作组于1972-01至1973-12间登记的1 314例AMI患者,2010s组数据来源于中国AMI注册登记(CAMI)研究2013-01-01至2014-09-30期间北京地区入选的2 200例AMI患者。比较两组患者的人口学特征(包括性别、年龄和农民比例)、危险因素和诱发因素方面差异。结果:与1970s组相比,2010s组AMI患者中>70岁患者比例(15.8 %vs 25.6%,P<0.001)、男性比例(68.3% vs75.6%,P<0.001)和农民比例(6.5%vs 14.5%,P<0.001)均增加。与1970s组相比,2010s组AMI患者中既往卒中史(6.2% vs 10.5%,P<0.001)、既往心肌梗死史(9.5% vs 11.9%,P<0.05)及合并糖尿病比例(6.2% vs 27.6%,P<0.001)明显升高。与1970s组相比,2010s组由于精神应激的AMI患者比例降低(51.1% vs 15.2%,P<0.001)、体力应激诱发的AMI患者比例增高(40.0% vs 61.1%,P=0.007)。结论:近40年,北京地区AMI患者的年龄、性别、农民比例,卒中史、心肌梗死史及糖尿病患者比例发生了巨大的变化,呈现老龄化、男性化、农村化的趋势,体力应激和不良的生活方式是当代AMI的主要诱发因素。对此变化趋势应开展更有针对性的心脏病预防和教育项目。
文摘Background No-reflow after emergency percutaneous coronary intervention （PCI） for acute ST segment elevation myocardial infarction （STEMI） is related to the severe prognosis. The aim of this study was to evaluate the efficacy of Tongxinluo, a traditional Chinese medicine, on no-reflow and the infarction area after emergency PCI for STEMI.Methods A total of 219 patients （female 31, 14%） undergoing emergency PCI for STEMI from nine clinical centers were consecutively enrolled in this randomized, double-blind, placebo-controlled, multicenter clinical trial from January 2007 to May 2009. All patients were randomly divided into Tongxinluo group （n=108） and control group （n=111）, given Tongxinluo or placebo in loading dose 2.08 g respectively before emergency PCI with asprin 300 mg and clopidogrel 300 mg together, then 1.04 g three times daily for six months after PCI. The ST segment elevation was recorded by electrocardiogram at hospitalization and 1, 2, 6, 12, 24 hours after coronary balloon dilation to evaluate the myocardial no-flow; myocardial perfusion scores of 17 segments were evaluated on day 7 and day 180 after STEMI with static single-photon emission computed tomography （SPECT） to determine the infarct area.Results There was no statistical significance in sex, age, past history, chest pain, onset-to-reperfusion time, Killip classification, TIMI flow grade just before and after PCI, either in the medication treatment during the follow up such as statin, β-blocker, angiotensin converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） between two groups. There was significant ST segment restoration in Tongxinluo group compared to the control group at 6 hours （（-0.22±0.18） mV vs. （-0.18±0.16） mV, P=0.0394）, 12 hours （（-0.24 ± 0.18） mV vs. （-0.18±0.15） mV, P=0.0158） and 24 hours （（-0.27±0.16） mV vs. （-0.20±0.16） mV, P=0.0021） reperfusion; and the incidence of myocardial no-reflow was also reduced significantly at 24-hour reperfusion （34.3% vs. 54.1%, P=0.0031）. The myocardial perfusion scores of 17 segments evaluated by static SPECT was improved significantly on day 7 and day 180 after STEMI in Tongxinluo group compared to the control group （0.61±0.40 vs. 0.76±0.42, P=0.0109 and 0.51 ±0.42 vs. 0.66±0.43, P=0.0115, respectively）.There was no significant difference in severe adverse events between two groups.Conclusion Tongxinluo as a kind of traditional Chinese medicine could reduce myocardial no-reflow and infarction area significantly after emergency PCl for STEMI with conventional medicine therapy.
文摘Background The traditional Chinese medicine injury, but the mechanism of its action is not we protective role of Tongxinluo. Tongxinluo can protect myocardium against documented. We examined the involvement schaemia/reperfusion of nitric oxide in the Methods Miniswine were randomized to four groups of seven： sham, control, Tongxinluo and Tongxinluo coadministration with a nitric oxide synthase inhibitor N^ωnitro-L-arginine （L-NNA, 10 mg/kg i.v.）. Three hours after administration of Tongxinluo, the animals were anaesthetised and the left anterior descending coronary artery ligated and maintained in situ for 90 minutes followed by 3 hours of reperfusion before death. Area of no reflow and necrosis and risk region were determined pathologically by planimetry. The degree of neutrophil accumulation in myocardium was obtained by measuring myeloperoxidase activity and histological analysis. Myocardial endothelial nitric oxide synthase activity and vascular endothelial cadherin content were measured by colorimetric method and immunoblotting analysis respectively. Results Tongxinluo significantly increased the local blood flow and limited the infarct and size of no reflow. Tongxinluo also attenuated myeloperoxidase activity and neutrophil accumulation in histological sections and maintained the level of vascular endothelial cadherin and endothelial nitric oxide synthase activity in the reflow region when compared with control group. The protection of Tongxinluo was counteracted by coadministration with L-NNA. Conclusions Tongxinluo may limit myocardial ischaemia and protect the heart against reperfusion injury. Tongxinluo regulates synthesis of nitric oxide by altering activity of endothelial nitric oxide synthase.
