Background Glycoprotein （GP） Ⅱb/Ⅲa antagonist has been shown its efficacy and safety in high-risk patients with acute coronary syndrome （ACS） who underwent percutaneous coronary intervention （PCI）. Whether GP...Background Glycoprotein （GP） Ⅱb/Ⅲa antagonist has been shown its efficacy and safety in high-risk patients with acute coronary syndrome （ACS） who underwent percutaneous coronary intervention （PCI）. Whether GP Ⅱb/Ⅲa antagonist is as effective and safe in older patients （ ≥ 65 years old ） as in younger patients remains unclear. Objectives Our objective was to determine whether GP Ⅱb/Ⅲa antagonist tirofiban was effective and safe in patients aged ≥65 years who underwent PCI. Methods From September 2006 to August 2008, 622 patients with non-ST-elevation ACS （NSTE ACS） were randomized to receive either tirofiban （n = 313 ） or placebo （n = 309）. The infusion duration was 48 hours for both groups. Incidence of major adverse cardiac events （MACE） was assessed at 180 days. Incidence of bleeding was monitored through 24 hours after trial therapy was discontinued. Results The incidence of MACE for the tirofiban group versus the placebo group was 7.3% vs 12. 6% （P 〈0. 05）. Among these MACE, death rate was 2.6% vs 4. 6 % （ P = 0. 198 ）, non-fatal MI was 3.8 % vs 6.5 % （ P = 0. 150）, and target vessel revascularization was 1.3% vs 1.6% （P =0. 751 ）, in the two groups, respectively. The total bleeding rate for the tirofiban group versus the placebo group was 28.1% vs 6.8% （P 〈0. 05 ）. The TIMI major and minor bleeding rates for the tirifiban versus the placebo group were 2.2% vs 1.6% （ P 〉 0. 05 ） and 25.9% vs 5.2% （ P 〈 0. 05 ）, respectively. Conclusions Tirofiban appears to be effective and safe in older patients with ACS who underwent PCI.展开更多
Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoi...Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention （PCI）. We compared the two treatments in this patient population.展开更多
AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domai...AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12.1 years old; 80% males),two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction(STEMI) patients(in which reperfusion wassuccessfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction(NSTEMI) patients(percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event(95%CI of the mean 23.3-28.0). Primary endpoint was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events(MCE,defined as mortality or readmission for new MI,new revascularization,episodes of heart failure or stroke). Possible correlations between HRV parameters(mainly the standard deviation of all normal RR intervals,SDNN),clinical features(age,sex,type of MI,history of diabetes,left ventricle ejection fraction),angiographic characteristics(number of coronary arteries with critical stenoses,success and completeness of revascularization) and long-term outcomes were analysed.RESULTS Markedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN(χ~2 =1.536,P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis(respectively: P = 0.008 and P = 0.008),while no correlation was found between depressed SDNN and history of previous MI(P = 0.999) or number of diseased coronary arteries(P = 0.428) or unsuccessful percutaneous coronary intervention(PCI)(P = 0.691). Patients with left ventricle ejection fraction(LVEF) < 40% presented more often SDNN values in the lowest quartile(P < 0.001). After > 2 years from infarction,a total of 10 patients(3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI(P = 0.141),although all-cause and cardiac mortality were higher among NSTEMI cases(respectively: 14% vs 2%,P = 0.001; and 10% vs 1.5%,P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN(respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles(P = 0.540),with no difference for STEMI(P = 0.180) or NSTEMI patients(P = 0.541). By the contrary,eventsfree survival was worse if patients presented with LVEF < 40%(P = 0.001).CONCLUSION In our group of patients with a recent complicated MI,abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases,and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression ofHRV parameters recorded in the subacute phase of the disease,both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.展开更多
Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous...Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharma- cological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations.展开更多
Penetrating atherosclerotic ulcer(PAU),an uncommon etiology of acute aortic syndrome(AAS),is a potential cause of chest pain seen in emergency departments.As PAU may lead to electrocardiogram(ECG)changes or rarely,ele...Penetrating atherosclerotic ulcer(PAU),an uncommon etiology of acute aortic syndrome(AAS),is a potential cause of chest pain seen in emergency departments.As PAU may lead to electrocardiogram(ECG)changes or rarely,elevated troponin levels,it is most likely misdiagnosed as acute coronary syndrome(ACS).Hence,individuals with PAU may be offered potentially life-threatening treatment.This paper reports a case of a 81-year-old male who presented with intermittent chest pain with a history of old inferior myocardial infarction and stent placement in the left circumflex coronary artery(LCX)three years ago.Initially,he was diagnosed with non-ST-elevation myocardial infarction(NSTEMI)based on abnormal ECG changes and raised troponin I.However,emergency coronary angiography(CAG)showed no restenosis in the left circumflex coronary artery(LCX)but with mild stenosis in the left anterior descending artery(LAD)and right coronary artery(RCA).Computed tomographic angiography(CIA)of the whole aorta showed multiple atherosclerotic plaques with penetrating atherosclerotic ulcer in the aortic arch and descending aorta.Endovascular aortic repair with Ankura II covered stent was performed.This case study reminds us that it is clinically difficult to distinguish PAU from ACS.Upon excluding ACS from the diagnosis,we should take into consideration of PAU,especially in elderly patients with positive cTnI.展开更多
文摘Background Glycoprotein （GP） Ⅱb/Ⅲa antagonist has been shown its efficacy and safety in high-risk patients with acute coronary syndrome （ACS） who underwent percutaneous coronary intervention （PCI）. Whether GP Ⅱb/Ⅲa antagonist is as effective and safe in older patients （ ≥ 65 years old ） as in younger patients remains unclear. Objectives Our objective was to determine whether GP Ⅱb/Ⅲa antagonist tirofiban was effective and safe in patients aged ≥65 years who underwent PCI. Methods From September 2006 to August 2008, 622 patients with non-ST-elevation ACS （NSTE ACS） were randomized to receive either tirofiban （n = 313 ） or placebo （n = 309）. The infusion duration was 48 hours for both groups. Incidence of major adverse cardiac events （MACE） was assessed at 180 days. Incidence of bleeding was monitored through 24 hours after trial therapy was discontinued. Results The incidence of MACE for the tirofiban group versus the placebo group was 7.3% vs 12. 6% （P 〈0. 05）. Among these MACE, death rate was 2.6% vs 4. 6 % （ P = 0. 198 ）, non-fatal MI was 3.8 % vs 6.5 % （ P = 0. 150）, and target vessel revascularization was 1.3% vs 1.6% （P =0. 751 ）, in the two groups, respectively. The total bleeding rate for the tirofiban group versus the placebo group was 28.1% vs 6.8% （P 〈0. 05 ）. The TIMI major and minor bleeding rates for the tirifiban versus the placebo group were 2.2% vs 1.6% （ P 〉 0. 05 ） and 25.9% vs 5.2% （ P 〈 0. 05 ）, respectively. Conclusions Tirofiban appears to be effective and safe in older patients with ACS who underwent PCI.
文摘Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention （PCI）. We compared the two treatments in this patient population.
文摘AIM To assess the prevalence of depressed heart rate variability(HRV) after an acute myocardial infarction(MI),and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODS Time-domain HRV(obtained from 24-h Holter recordings) was assessed in 326 patients(63.5 ± 12.1 years old; 80% males),two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction(STEMI) patients(in which reperfusion wassuccessfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction(NSTEMI) patients(percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event(95%CI of the mean 23.3-28.0). Primary endpoint was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events(MCE,defined as mortality or readmission for new MI,new revascularization,episodes of heart failure or stroke). Possible correlations between HRV parameters(mainly the standard deviation of all normal RR intervals,SDNN),clinical features(age,sex,type of MI,history of diabetes,left ventricle ejection fraction),angiographic characteristics(number of coronary arteries with critical stenoses,success and completeness of revascularization) and long-term outcomes were analysed.RESULTS Markedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN(χ~2 =1.536,P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis(respectively: P = 0.008 and P = 0.008),while no correlation was found between depressed SDNN and history of previous MI(P = 0.999) or number of diseased coronary arteries(P = 0.428) or unsuccessful percutaneous coronary intervention(PCI)(P = 0.691). Patients with left ventricle ejection fraction(LVEF) < 40% presented more often SDNN values in the lowest quartile(P < 0.001). After > 2 years from infarction,a total of 10 patients(3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI(P = 0.141),although all-cause and cardiac mortality were higher among NSTEMI cases(respectively: 14% vs 2%,P = 0.001; and 10% vs 1.5%,P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN(respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles(P = 0.540),with no difference for STEMI(P = 0.180) or NSTEMI patients(P = 0.541). By the contrary,eventsfree survival was worse if patients presented with LVEF < 40%(P = 0.001).CONCLUSION In our group of patients with a recent complicated MI,abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases,and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression ofHRV parameters recorded in the subacute phase of the disease,both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised.
文摘Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharma- cological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations.
基金2018 Joint Construction Project of Henan Medical Science and Technology Research Plan(Project Number:2018020541)。
文摘Penetrating atherosclerotic ulcer(PAU),an uncommon etiology of acute aortic syndrome(AAS),is a potential cause of chest pain seen in emergency departments.As PAU may lead to electrocardiogram(ECG)changes or rarely,elevated troponin levels,it is most likely misdiagnosed as acute coronary syndrome(ACS).Hence,individuals with PAU may be offered potentially life-threatening treatment.This paper reports a case of a 81-year-old male who presented with intermittent chest pain with a history of old inferior myocardial infarction and stent placement in the left circumflex coronary artery(LCX)three years ago.Initially,he was diagnosed with non-ST-elevation myocardial infarction(NSTEMI)based on abnormal ECG changes and raised troponin I.However,emergency coronary angiography(CAG)showed no restenosis in the left circumflex coronary artery(LCX)but with mild stenosis in the left anterior descending artery(LAD)and right coronary artery(RCA).Computed tomographic angiography(CIA)of the whole aorta showed multiple atherosclerotic plaques with penetrating atherosclerotic ulcer in the aortic arch and descending aorta.Endovascular aortic repair with Ankura II covered stent was performed.This case study reminds us that it is clinically difficult to distinguish PAU from ACS.Upon excluding ACS from the diagnosis,we should take into consideration of PAU,especially in elderly patients with positive cTnI.
