Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS

Long Term Clinical and Angiographic Outcome Following Percutaneous Transluminal Angioplasty and Stent Placement for Iliac and Femoral Artery Stenosis

Objective This study reportsthe initial and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac and femoral arteries. Methods and Results From December 1994 to March 1997, we performed iliac and femoral artery angioplasty and primary intravascular stent placement in 37 vessel of 33 patients (19 men and 14 women; mean age, 70. 5 years). A total of 43 self - expanding Wallstents (Boston, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Clinical follow - up was available for all patients at a mean of 26±14months. All patient clinical is-chemic category (claudication or rest pain) was improved. Angiographic follow - up was completed for 17 of 23 patients at a mean follow-up of 10±5 months, The iliac artery restenosis rate was 0(0/8). The femoral artery restenosis rate was 33 % (3/9), All 3 patients underwent repeat balloon angioplasty successfully. Conclusion The iliac and femoral arteries can be performed and reasonable early and late patency rates.

Illness Perception, Treatment Adherence and Coping in Persons with Coronary Artery Disease Undergoing Angioplasty

Background and Objective: Coronary artery disease (CAD) is the leading cause of sudden death. In this article, we compared patients’ illness perception (IP), treatment adherence and coping mechanisms of patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Methods: In this descriptive, prospective observational study IP, treatment adherence and coping of 140 patients were evaluated pre-PTCA, at the time of hospital discharge and 1 to 3 months post-PTCA by Illness Perception Questionnaire, Morisky Treatment Adherence and Carver’s brief COPE questionnaires. Results: 1 - 3 months post-PTCA, all dimensions of IP changed significantly except personal and treatment control. Adherence scores decreased simultaneously. With respect to coping mechanisms, all increased except behavioral disengagement, emotional support, instrumental support and religion which decreased significantly post-PTCA. Conclusions: In Overall, an improved IP and increased use of controllable causal attributions led to an increase in medication adherence and adaptive coping strategies. Post-treatment health behaviors are predictable by assessing patients’ illness-related beliefs beforehand.

Sequential treatment for diabetic foot ulcers in dialysis patients:A case report

BACKGROUND Diabetic foot ulcers(DFUs)are common in patients with diabetes,especially those undergoing hemodialysis.In severe cases,these ulcers can cause damage to the lower extremities and lead to amputation.Traditional treatments such as flap transposition and transfemoral amputation are not always applicable in all cases.Therefore,there is a need for alternative treatment methods.CASE SUMMARY This report describes a 62-year-old female patient who was admitted to the hospital with plantar and heel ulcers on her left foot.The patient had a history of renal failure and was undergoing regular hemodialysis.Digital subtraction angiography showed extensive stenosis and occlusion in the left superficial femoral artery,left peroneal artery and left posterior tibial artery.Following evaluation by a multidisciplinary team,the patient was diagnosed with type 2 DFUs(TEXAS 4D).Traditional treatments were deemed unsuitable,and the patient was treated with endovascular surgery in the affected area,in addition to supportive medical treatment,local debridement,and sequential repair using split-thickness skin and tissue-engineered skin grafts combined with negative pressure treatment.After four months,the wound had completely healed,and the patient was able to walk with a walking aid.CONCLUSION This study demonstrates a new treatment method for DFUs was successful,using angioplasty,skin grafts,and negative pressure.

Specialty Balloons and Vessel Prepping in Peripheral Artery Disease

Peripheral Artery Disease (PAD) is a global disease that affects more than 200 million individuals worldwide with an ever-increasing prevalence rate from year to year. Peripheral Artery Disease treatments include everything from lifestyle interventions to surgical revascularization or percutaneous angioplasty (PTA). Percutaneous Angioplasty (PTA) has become the primary treatment for this disease with the use of focal force and scoring balloons for vessel prepping. The practice of vessel prepping looks to limit the effect of angioplasty on vessel dissection and recoiling in the infrainguinal region during the treatment of plaque buildup in the vessel. Plaque morphology and rise in incidence of in-stent restenosis can determine which balloon device is best used when restoring a vessel. Some of the different brands we review in this chapter include Peripheral Cutting Balloons by Boston Scientific, Chocolate PTA by Medtronic, Angiosculpt balloon by Philips, and VascuTrak by BARD. In review of Angiosculpt balloon by Philips: The study concluded that the one-year data supports the notion that the AngioSculpt Scoring Balloon is an effective and safe treatment option for infrapopliteal, atherosclerotic lesions in patients with critical limb ischemia. Whereas: Peripheral cutting balloons (PCBs) by Boston Scientific have been used for in-stent restenosis, resistant lesions, small vessels, bifurcations, aortaostial lesions, and saphenous vein graft lesions. This chapter will discuss different focal force and scoring balloon devices available to treat different plaque morphology and usefulness for in-stent restenosis resolution. We will review the evidence associated with each brand of device and the factors that should be accounted for before making a decision on which to use for your patient.

Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ITS SUCCESS RATE AND AFFECTING FACTORS

From December 1987 to October 1983, percutaneous transluminal coronary angioplasty (PTCA) was performed in 302 patients with 392 diseased vessels and 440 lesions. The success rate was 93.71% in 302 patients, 94.90% in 392 diseased vessels and 95.00% in 440 lesions. The success rate was 98.92% in Type A lesion, 95.71% in Type B lesion, and 86.57% in Type C lesion (A vs B P=NS, A vs C P<0.01). There were 55 lesions with total or subtotal occlusion, the success rate was 89.09% (93.10% in Type B lesion and 84.62% in Type C lesion). As to the diseased vessels, the success rate was 95.65% in LAD, 94.38% in LCX and 93.75% in RCA. The results showed no significant difference. In this series, acute ischemic complications were found in 6.59% (29 / 440). Of these 29 lesions, 23 were treated successfully, 5 developed Q wave myocardial infarction and 1 died.

Iatrogenic aortic dissection during right transradial intervention in a patient with aberrant right subclavian artery:A case report

BACKGROUND Aberrant right subclavian artery(ARSA)is the most common congenital anomaly of the aortic arch.When patients having such anomalies receive transradial intervention(TRI),aortic dissection(AD)may occur.Herein,we discuss a case of iatrogenic type B AD occurring during right TRI in an ARSA patient,that was later salvaged by percutaneous angioplasty.CASE SUMMARY A 73-year-old man presented to our hospital with intermittent chest pain.Coronary computed tomography(CT)angiography revealed significant stenosis in the left anterior descending artery.Diagnostic coronary angiography was performed via the right radial artery without difficulty.However,we were unable to advance the guiding catheter past the ostium of the right subclavian artery to the aortic arch for percutaneous coronary intervention,while the guidewire tended to go down the descending aorta.The patient suddenly complained of chest and back pain.Emergent CT aortography revealed type B AD propagating to the left renal artery(RA)with preserved renal perfusion.However,after 2 d,the patient suddenly complained of right lower limb pain where the femoral pulse was suddenly undetectable.Follow-up CT indicated further progression of dissection to the right external iliac artery(EIA)and left RA with limited flow.We performed percutaneous angioplasty of the right EIA and left RA without complications.Follow-up CT aortography at 8 mo showed optimal results.CONCLUSION A caution is required during right TRI in ARSA to avoid AD.Percutaneous angioplasty can be a treatment option.

PERCUTANEOUS TRANSLUMINAL EXCIMER LASER CORONARY ANGIOPLASTY CLINICAL REPORT OF SIX CASES

Six patients with 95% to 100% occluded atheroseleroticlesions underwent percutaneous transluminal excimer lasercoronary angioplasty (PTELCA). Among them, 5 were maleand ! was female; their age ranged from 28 to 66 years. Fourpatients had LAD stenosis and 2 LCX lesions.Acuteangiographic and clinical success was achieved in all patientsbut one, with a success rate Of 83.3%. It was demonstratedthat PTELCA is a safe and effective therapy for selected pa-tients with coronary artery disease.

Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.

Plaque increase may be an important contributor to late restenosis after percutaneous transluminal coronary balloon angioplasty

There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.

Clinical and angiographic significance of exercise induced ST-segment elevation in patients without previous myocardial infarction

Objective To study the clinical significance of exercise-induced ST-segment elevation(STE)in patients without previous myocardial infarction(MI). Methods Ten patients without previous MI who developed STE during exercise testing were underwent coronary angiography, left ventriculography and rest electrocardiography, and Bruce protocol were used during exercise test. Results The incidence of exercise induced STE in patients without previous MI was 0.28%(10/3564). One of the 10 patients had only a mild coronary lesion (stenosis < 35%in diameter) in left anterior descending artery, but she developed an acute myocardial infarction 4 weeks after coronary angiography,and the leads of myocardial infarction and the leads of exercise induced STE elevation were same, the others all had severe coronary stenosis(90%～100%). There was a good correlation between leads of ST segment elevation and ischemic related artery. Nine patients received invasive therapy. During a period of 28 months (range 8 to 48 months) of follow up, 2 of them received PTCA again at 11 and 19 months after their discharge, prospectively. Conclusions The findings indicats ST elevation during exercise is a specific marker of severe transmural regional ischemia and should be an indication for coronary angiography. Most patients with exercise induced ST segment elevation have critical organic stenosis of the ischemic-related coronary artery and are candidates for myocardial revascularization. In a few patients, ST segment elevation during exercise may be caused by coronary artery spasm in the absence of significant organic lesions, and they may have a poor prognosis.

Percutaneous renal artery angioplasty and stenting for pulmonary edema caused by Takayasu's arteritis:A case report

Takayasu arteritis （TA） commonly occurs in woman younger than 50 years old and can manifest as isolated, atypical and/or catas- trophic disease. The disease can implicate in any or all of the major organs I As a chronic relapsing and remitting disorder, the overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The overall mortality rate of TA depends on the severity of the le- sions and involved organs.

Effects of upstream tirofiban versus downstream tirofiban on myocardial damage and 180-day clinical outcomes in high-risk acute coronary syndromes patients undergoing percutaneous coronary interventions

Background For patients with moderate to high-risk acute coronary syndromes （ACS） who undergo early, invasive treatment strategies, current guidelines recommend the usage of glycoprotein （GP） lib/Ilia inhibitors as an upstream treatment for a coronary care unit or as an downstream provisional treatment for selected patients who are undergoing percutaneous coronary intervention （PCI）. The relative advantage of either strategy is unknown. The purpose of this study was to evaluate the effects of upstream tirofiban versus the effects of downstream tirofiban on myocardial damage and 180-day major adverse cardiovascular events （MACE） after PCI in high-risk non-ST-segment elevation ACS （NSTE-ACS） undergoing PCI. Methods From July 2006 to July 2007, 160 high-risk NSTE-ACS undergoing PCI were randomized to receive upstream （within 4-6 hours before coronary angiography） tirofiban or downstream （the guidewire crossing the lesion） tirofiban, to evaluate the extent of myocardial damage after PCI by quantitatively and qualitatively analyzing the value of cardiac troponin I （cTnl） as well as MB isoenzyme of creatine kinase （CK-MB） before and after PCI. The incidences of 24-hour, 3-day, 7-day, 30-day and 180-day MACE after PCI were followed up and the rates of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results The peak release and cumulative release of cTnl levels within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.45 vs 0.63 and 0.32 vs 0.43, respectively; P 〈0.05）. Post-procedural cTnl elevation within 48 hours was significantly less frequent among patients who received the upstream tirofiban than those who received the downstream tirofiban （66.3% vs 87.5%, P 〈0.05）. The peak and cumulative release of CK-MB levels as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （16 vs 14,5 vs 3 and 26.3% vs 36.3%, respectively; P 〉0.05）. The incidences of 24-hour, 3-day, and 7-day MACE after PCI were the same between the two groups （0 vs 0, 0 vs 0 and 1.25% vs 1.25%, respectively）. Although the incidences of 30-day and 180-day MACE after PCI were not statisticially different between the two groups, the incidences were consistently lower with upstream tirofiban （3.75% vs 6.25% and 12.99% vs 16.67%; P 〉0.05）. Aging （OR=1.164, P 〈0.001）, hypertension （OR=4.165, P=0.037） and type 2 diabetes （OR=13.628, P 〈0.001） were independent risk factors of MACE. The timing of administrating the tirofiban （OR=2.416, P=-0.153） plays an extensive role in the incidence of MACE. The incidences of major and minor bleeding complications as well as mild thrombocytopenia during the administration of tirofiban were similar between the two groups （2.50% vs 1.25%, 1.25% vs 1.25% and 1.25% vs 1.25%, respectively; P 〉0.05）. Conclusions Based on the pretreatment with aspirin and clopidogrel, upstream tirofiban was associated with attenuated minor myocardial damage and the tendency of reducing incidences of 180-day MACE after PCI among high-risk NSTE-ACS patients undergoing PCI. Aging, hypertension and type 2 diabetes were independent risk factors of MACE in high-risk NSTE-ACS patients undergoing PCI associated with tirofiban.

The influence of admission glucose on epicardial and microvascular flow after primary angioplasty

Background Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited. Methods Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level： group 1, 〈7.8 mmol/L; group 2, （7.8 - 11.0） mmol/L; and group 3, ≥ 11.0 mmol/L. Results Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides （TG） in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction （TIMI） 3 flow after percutaneous coronary intervention （PCI） （89.7%, 86.0% and 86.3%, P=NS）. However, corrected TIMI frame count （CTFC） in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade （TMPG） 0-1 grade among patients with hyperglycemia after PCI were more frequent （30.9% and 29.0% vs 17.3%, P〈0.05）. There was less frequent complete ST-segment resolution （STR） and early T wave inversion among patients with hyperglycemia after PCI. Conclusion Elevated admission glucose levels in ST-segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.

Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical outcomes in ST-elevated myocardial infarction after percutaneous coronary intervention

Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutaneous coronary intervention （PCI）. The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. Methods A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution （ST-R） and myocardial blush grades （MBG） were evaluated immediately after PCI. Left ventricular ejection fraction （LVEF） was obtained at baseline and 12-18 months after PCI. Results Postprocedural WBC count was an independent inverse predictor of ST-R （OR 0.80, P 〈0.0001） and MBG 3 （OR 0.82, P 〈0.0001）. It was negatively correlated with LVEF （baseline r=0.22, P=0.001; 12-18 months r=0.29, P 〈0.0001）. The best cutoff value of WBC for predicting death was determined to be 13.0×10^9/L. The patients with a postprocedural WBC count above 13.0×10^9/L showed a significantly lower cumulative survival rate （30 days, 82.4% vs. 99.0%, P 〈0.0001 and 2 years 75.0% vs. 96.4%, P 〈0.0001）. Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality （HR 8.48, P=0.019） and 2-year mortality （HR 4.93, P=0.009）. Conclusions Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.

EXPERIMENTAL WORK AND RESEARCH The Experimental Study of Xue Guan Tong（血管通）on PreventingRestenosis after Percutaneous Transluminal A

The effect of Xue Guen Tong (XGT) granule in preveriting restenosis of atherosclerotic iliacartery after percutaneous transluminal angioplasty (PTA) in rabbits was studied. Forty-two purebred NewZealand rabbits with their endothelium of iliac arteries denuded and fed with high cholesterol diet for sixweeks to form the model of atheresclerotic stenosis. After PTA, the high cholesterol diet was stopped imme-diately and they were divided into 3 groups randomly. the XGT group, the lovastatin group and the controlgroup. Arterial angiogreph and pathological observation were carried out 4 weeks after PTA. The resultesbewed that ( 1 ) The luminal diameter of artery was 1 . 82 0. 46mm in the XGT group, 0 . 96 0. 71mm in thelovastetin grcxjp and 0. 71 0 . 53mm in the control group. The former one was larger than the latter two sig-nificantly ( P< 0. 01 ) . (2) Thickness of intima of artery was 0 . 27 0 . 40mm in the XGT group, it was thinnerthan those in the other two groups (O. 43 0. 04mm in the lovastatin group arid 0. 48 0. 10mm in the controlgroup) . (3) In XGT group, the smooth muscle cells ( SMCs) contained fewer organelles. more muscular fibersand were well differentiated than in the other two groups. The conclusion was XGT has the preventive effecton past-PTA arterial restenosis in rabbits.

Successful percutaneous coronary intervention reduces plasma concentration of NT-proBNP in patients with coronary heart disease and normal ventricular function

Background To the effect of percutaneous coronary intervention （PCI） on plasma level of N-terminal pro-B-type natriuretic peptide （NT-proBNP） in patients with coronary heart disease （CHD） and normal left ventricular function. Methods One hundred and five patients with CHD and normal ventricular function were enrolled. Blood samples for assessment of NT-proBNP and cTn-T were collected before and after PCI. Results The mean left ventricular ejection fraction was 60.3 ± 5.3%. After revascularization, the level of lgNT-proBNP was signifi-cantly reduced （2.40 ± 0.44 vs 2.23± 0.43, P 〈 0.001）. Subgroup analysis showed that the level of lgNT-proB-NP ws consistently decreased in different clinical classifications （stable angina： 45, unstable angina： 31 and acute myocardial infarction： 29） and target-vessel revascularization （left anterior descending artery： 30, left cir-cumflex artery： 26 and right coronary artery： 49）, and in 99 patients without elevation of post-procedural cTn- T, but it showed a trend of non-significant increase in 6 patients with elevated cTn-T. Conclusions Our study demonstrates that successful PCI reduces plasma NT-proBNP concentration in patients with CHD and normal ven-tricular function. This implicates that the impact of PCI should be considered in the interpretation of NT-proBNP change in clinical practice, and further studies are necessary to investigate the direct and/or indirect effect of myocardial ischemia on BNP/NT-proBNP.

Clinical Study on The rapeutic Mechanism of Sini Decoction (四逆汤) in Treating Post-Percutane ous Transluminal Coronary Angioplasty Ische mia-Reperfusion In jury in Terms of Syndrome Typing of TCM

Objective: To study the mechanism of Sini Decoction (SND) in prevention and treatment of post-percutaneous transluminal coronary angioplasty (PTCA) ischemia-reperfusion injury with different Syndrome typing of TCM.Methods: Forty patients who received PTCA were randomly divided equally into the SND group and the control group, there were 10 of Excess Syndrome (ES) and 10 of Deficiency Syndrome (DS)in each group.25 ml SND was gi ven daily to the SND group from 3 days before operation to the third day after operation. The blood superoxide dismutase (SOD) activity, malondialdehyde (MDA) and nitric oxide (NO) content of patients were determined before PTCA, and 1 hr, 12 hrs, 24 hrs, 48 hrs and 72 hrs after PTCA. Results: Before PTCA, the cases with DS were characterized by low SOD activity and high MDA content, as compared with the patients with ES, P<0.05. SND could relieve the post-PTCA deprivation of SOD activity and NO content and the elevation of MDA level in both ES and DS patients, the amplitude of elevation of SOD activity in DS patients was higher than that in ES patients (P<0.05). Conclusion: SND has antagonizing effect on post-PTCA ischemia-reperfusion injury, which is more effective in treating patients with DS.

Study on Influence of Sini Decoction (四逆汤) on Quality of Life of Patients after Percutane ous Transluminal Coronary Angioplasty

Objective: To determine the influence of Sini Decoction (SND) on quality of life(QOL) of patients after percutaneous transluminal coronary angioplasty (PTCA). Methods: Randomized case-control clinical trial was conducted to evaluate QOL of 40 post-PTCA patients before and after SND treatment by scoring. Results: The scores in physical symptoms, sense of well-being, degree of depression, index of satisfaction of life and work capacity of the patients after PTCA were improved significantly as compared with before PTCA, P<0.01. Scores of patients who received SND treatment were higher than those untreated with SND in the first three criteria, P<0.05, particularly in relieving palpitation and dyspnea. Conclusion: SND is helpful in improving QOL of patients after PTCA.