Background Rapid recanalization of infarct-related artery （IRA） has become the major target during primary percutaneous coronary intervention （PCI） for patients with ST-elevation myocardial infarction （MI）, but ...Background Rapid recanalization of infarct-related artery （IRA） has become the major target during primary percutaneous coronary intervention （PCI） for patients with ST-elevation myocardial infarction （MI）, but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.Methods A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries （luminal narrowing 〉70%） undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only （group 1）, and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction （AMI） （group 2）. Drug-eluting stents （DESs） were deployed in more than 90% of the patients. Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events （11.5% vs 15.1%, P 〉0.05） and target lesion revascularization （8.1% vs 7.6%, P 〉0.05） between the two groups. However, patients in group 1 had higher rates of recurrent angina （10.1% vs 2.1%, P 〈0.05） and depressed left ventricular ejection fraction evaluated by echocardiography （0.56±0.22 vs 0.63±0.25, P 〈0.05）. Conclusion With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation Mt and multi-vessel disease.展开更多
Background:Limited data are available on the comparison of clinical outcomes of complete vs.incomplete percutaneous coronary intervention(PCI)for patients with chronic total occlusion(CTO)and multi-vessel disease(MVD)...Background:Limited data are available on the comparison of clinical outcomes of complete vs.incomplete percutaneous coronary intervention(PCI)for patients with chronic total occlusion(CTO)and multi-vessel disease(MVD).The study aimed to compare their clinical outcomes.Methods:A total of 558 patients with CTO and MVD were divided into the optimal medical treatment(OMT)group(n=86),incomplete PCI group(n=327),and complete PCI group(n=145).Propensity score matching(PSM)was performed between the complete and incomplete PCI groups as sensitivity analysis.The primary outcome was defined as the occurrence of major adverse cardiovascular events(MACEs),and unstable angina was defined as the secondary outcome.Results:At a median follow-up of 21 months,there were statistical differences among the OMT,incomplete PCI,and complete PCI groups in the rates of MACEs(43.0%[37/86]vs.30.6%[100/327]vs.20.0%[29/145],respectively,P=0.016)and unstable angina(24.4%[21/86]vs.19.3%[63/327]vs.10.3%[15/145],respectively,P=0.010).Complete PCI was associated with lower MACE compared with OMT(adjusted hazard ratio[HR]=2.00;95%confidence interval[CI]=1.23–3.27;P=0.005)or incomplete PCI(adjusted HR=1.58;95%CI=1.04–2.39;P=0.031).Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups(20.5%[25/122]vs.32.6%[62/190],respectively;adjusted HR=0.55;95%CI=0.32–0.96;P=0.035)and unstable angina(10.7%[13/122]vs.20.5%[39/190],respectively;adjusted HR=0.48;95%CI=0.24–0.99;P=0.046).Conclusions:For treatment of CTO and MVD,complete PCI reduced the long-term risk of MACEs and unstable angina,as compared with incomplete PCI and OMT.Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.展开更多
INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and th...INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery （ITA） grafting and Cooley＇s technique.展开更多
针对眼底图像中存在大量不规则、噪声干扰严重、边界模糊、分割难度较大的细小血管的问题,提出一种基于多方向特征和连通性检测的眼底图像分割方法MDF_Net&CD(Multi-Directional Features neural Network and Connectivity Detecti...针对眼底图像中存在大量不规则、噪声干扰严重、边界模糊、分割难度较大的细小血管的问题,提出一种基于多方向特征和连通性检测的眼底图像分割方法MDF_Net&CD(Multi-Directional Features neural Network and Connectivity Detection)。设计了一个以像素点不同方向特征向量为输入的深度神经网络模型MDF_Net(Multi-Directional Features neural Network),利用MDF_Net对眼底图像进行初步分割;提出连通性检测算法,根据血管的几何特征,对MDF_Net的初步分割结果进一步修订。在公开的眼底图像数据集上,将MDF_Net&CD与近期有代表性的分割方法进行实验对比,结果表明MDF_Net&CD各项评估指标均衡,敏感度,F1值和准确率优于其他方法。该方法能有效捕捉像素点的细节特征,对不规则、噪声干扰严重、边界模糊的细小血管有较好分割效果。展开更多
文摘Background Rapid recanalization of infarct-related artery （IRA） has become the major target during primary percutaneous coronary intervention （PCI） for patients with ST-elevation myocardial infarction （MI）, but strategy for treatment of non-IRA lesions in this setting remains unclear. This study aimed to compare long-term effects between PCI for IRA only and that for both IRA and non-IRA in ST-elevation MI patients with multi-vessel disease.Methods A total of 242 eligible patients with ST-elevation MI and at least two diseased coronary arteries （luminal narrowing 〉70%） undergoing primary PCI were included. Of them, 149 patients underwent primary PCI for IRA only （group 1）, and 93 received primary PCI for IRA followed by elective PCI for non-IRA 7 to 15 days after acute myocardial infarction （AMI） （group 2）. Drug-eluting stents （DESs） were deployed in more than 90% of the patients. Results The two groups did not differ with respect to baseline clinical and angiographic characteristics. No significant differences were observed in 12-month clinical follow-up results regarding major adverse cardiac events （11.5% vs 15.1%, P 〉0.05） and target lesion revascularization （8.1% vs 7.6%, P 〉0.05） between the two groups. However, patients in group 1 had higher rates of recurrent angina （10.1% vs 2.1%, P 〈0.05） and depressed left ventricular ejection fraction evaluated by echocardiography （0.56±0.22 vs 0.63±0.25, P 〈0.05）. Conclusion With the use of DESs, complete revascularization with elective PCI for non-IRA after primary PCI may exert a beneficial effect on long-term symptomatology and left ventricular function in patients with ST-elevation Mt and multi-vessel disease.
基金Beijing United Heart Foundation,Cardiacare Sponsored Optimizing Antithrombotic Research Fund(No.BJUHFCSOARF201801-02)Summit Talent Plan,Beijing Hospital Management Center(No.DFL20190101)
文摘Background:Limited data are available on the comparison of clinical outcomes of complete vs.incomplete percutaneous coronary intervention(PCI)for patients with chronic total occlusion(CTO)and multi-vessel disease(MVD).The study aimed to compare their clinical outcomes.Methods:A total of 558 patients with CTO and MVD were divided into the optimal medical treatment(OMT)group(n=86),incomplete PCI group(n=327),and complete PCI group(n=145).Propensity score matching(PSM)was performed between the complete and incomplete PCI groups as sensitivity analysis.The primary outcome was defined as the occurrence of major adverse cardiovascular events(MACEs),and unstable angina was defined as the secondary outcome.Results:At a median follow-up of 21 months,there were statistical differences among the OMT,incomplete PCI,and complete PCI groups in the rates of MACEs(43.0%[37/86]vs.30.6%[100/327]vs.20.0%[29/145],respectively,P=0.016)and unstable angina(24.4%[21/86]vs.19.3%[63/327]vs.10.3%[15/145],respectively,P=0.010).Complete PCI was associated with lower MACE compared with OMT(adjusted hazard ratio[HR]=2.00;95%confidence interval[CI]=1.23–3.27;P=0.005)or incomplete PCI(adjusted HR=1.58;95%CI=1.04–2.39;P=0.031).Sensitivity analysis of PSM showed similar results to the above on the rates of MACEs between complete PCI and incomplete PCI groups(20.5%[25/122]vs.32.6%[62/190],respectively;adjusted HR=0.55;95%CI=0.32–0.96;P=0.035)and unstable angina(10.7%[13/122]vs.20.5%[39/190],respectively;adjusted HR=0.48;95%CI=0.24–0.99;P=0.046).Conclusions:For treatment of CTO and MVD,complete PCI reduced the long-term risk of MACEs and unstable angina,as compared with incomplete PCI and OMT.Complete PCI in both CTO and non-CTO lesions can potentially improve the prognosis of patients with CTO and MVD.
基金supported by grants National Dis-tinguished Youth Science Fund (No.30525020)
文摘INTRODUCTIONLeft ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction （AMI）. Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery （ITA） grafting and Cooley＇s technique.
文摘针对眼底图像中存在大量不规则、噪声干扰严重、边界模糊、分割难度较大的细小血管的问题,提出一种基于多方向特征和连通性检测的眼底图像分割方法MDF_Net&CD(Multi-Directional Features neural Network and Connectivity Detection)。设计了一个以像素点不同方向特征向量为输入的深度神经网络模型MDF_Net(Multi-Directional Features neural Network),利用MDF_Net对眼底图像进行初步分割;提出连通性检测算法,根据血管的几何特征,对MDF_Net的初步分割结果进一步修订。在公开的眼底图像数据集上,将MDF_Net&CD与近期有代表性的分割方法进行实验对比,结果表明MDF_Net&CD各项评估指标均衡,敏感度,F1值和准确率优于其他方法。该方法能有效捕捉像素点的细节特征,对不规则、噪声干扰严重、边界模糊的细小血管有较好分割效果。
