梗死部位对急性心肌梗死经皮冠状动脉介入术患者预后的影响

急性心肌梗死早期快速开通梗死相关动脉（IRA），挽救濒死的心肌，保持乃至提高心功能，有效改善患者预后阻。但是即使成功施行了PCI治疗并及时开通IRA，仍有部分患者有再发心脏不良事件（MACE）的危险性，本文旨研究不同部位心肌梗死患者行急诊PCI术后对临床预后的影响。

高血压对急性ST段抬高型心肌梗死经皮冠状动脉介入近期预后的影响

目的探讨高血压对急性ST段抬高型心肌梗死(STEMI)行急诊经皮冠状动脉介入治疗(PCI)患者近期预后的影响。方法选取解放军白求恩国际和平医院2011年1月—2015年2月发病<12 h且行急诊PCI治疗的STEMI 805例,依据既往史分为对照组437例和高血压组368例,对两组一般资料进行单因素分析,对预后影响因素进行多因素回归分析。结果年龄、性别、高血压、糖尿病为STEMI急诊PCI后近期预后的独立危险因素。结论既往有高血压病的STEMI患者行PCI后近期主要心脏不良事件发生率增高,临床工作中应给予相应预防措施,以降低发生率。

B型钠尿肽与急性冠状动脉综合征预后评价

B型钠尿肽是主要由心室肌细胞在室壁张力增高情况下分泌的一种肽类激素,它对于充血性心衰的诊断、鉴别诊断和预后评价具有明确价值;B型钠尿肽水平在急性冠状动脉综合征患者中有一定的变化规律,但由于影响B型钠尿肽因素较多,限制了B型钠尿肽在急性冠状动脉综合征中的诊断价值,然而随着B型钠尿肽在急性冠状动脉综合征患者预后中研究的深入,发现B型钠尿肽可以成为急性冠状动脉综合征预后很好的预测指标。

炎症因子在急性冠状动脉综合征预后中的作用

为探讨C-反应蛋白、纤维蛋白原和肿瘤坏死因子α等炎症因子在急性冠状动脉综合征患者预后中的作用,连续观察了76例急性冠状动脉综合征患者入院时上述指标的变化,随访7～12个月,记录住院期间和出院后新发生的心血管事件。结果发现,随访期内发生心血管事件者C-反应蛋白和纤维蛋白原浓度高于未发生者,而肿瘤坏死因子α在对照组和急性冠状动脉综合征患者的浓度无差别;多因素Logistic回归分析发现,C-反应蛋白和纤维蛋白原是心血管事件的独立危险因素。表明C-反应蛋白和纤维蛋白原是判断急性冠状动脉综合征患者短期预后的有用指标,肿瘤坏死因子α对判断急性冠状动脉综合征患者的预后无价值。

Predictors and in-hospital prognosis of recurrent acute myocardial infarction

Objective To investigate the contributing factors and in-hospital prognosis of patients with or without recurrent acute myocardial infarction （AMI）. Methods A total of 1686 consecutive AMI patients admitted to Peking University People＇s Hospital from January 2010 to December 2015 were recruited. Their clinical characteristics were retrospectively compared between patients with or without a recurrent AMI. Then multivariable logistic regression was used to estimate the predictors of recurrent myocardial infarction. Results Recurrent AMI patients were older （69.3 ± 11.5 vs. 64.7 ± 12.8 years, P 〈 0.001） and had a higher prevalence of diabetes mellitus （DM） （52.2% vs. 35.0%, P 〈 0.001） compared with incident AMI patients, they also had worse heart function at admission, more severe coronary disease and lower reperfusion therapy. Age （OR = 1.03, 95% CI： 1.02-1.05; P 〈 0.001）, DM （OR = 1.86, 95% CI： 1.37-2.52; P 〈 0.001） and reperfusion therapy （OR = 0.74; 95% CI： 0.52-0.89; P 〈 0.001） were independent risk factors for recurrent AMI Recurrent AMI patients had a higher in-hospital death rate （12.1% vs. 7.8%, P = 0.039） than incident AMI patients. Conclusions Recurrent AMI patients presented with more severe coronary artery conditions. Age, DM and reperfusion therapy were independent risk factors for recurrent AMI, and recurrent AM1 was related with a high risk of in-hospital death.

Is frailty associated with short-term outcomes for elderly patients with acute coronary syndrome？

Background Frailty is a new prognostic factor in cardiovascular medicine due to the aging and increasingly complex nature of elderly patients. It is useful and meaningful to prospectively analyze the manner in which frailty predicts short-term outcomes for elderly patients with acute coronary syndrome （ACS）. Methods Patients aged 〉 65 years, with diagnosis of ACS from cardiology department and geriatrics department were included from single-center. Clinical data including geriatrics syndromes were collected using Comprehensive Geriatrics Assessment. Frailty was defined according to the Clinical Frailty Scale and the impact of the co-morbidities on risk was quantified by the coronary artery disease （CAD）--specific index. Patients were followed up by clinical visit or telephone consultation and the median follow-up time is 120 days. Following-up items included all-cause mortality, unscheduled return visit, in-hospital and recurrent major adverse cardiovascular events. Multivariable regression survival analysis was performed using Cox regression. Results Of the 352 patients, 152 （43.18%） were considered frail according to the study instrument （5-7 on the scale）, and 93 （26.42%） were considered moderately or se- verely frail （6-7 on the scale）. Geriatrics syndromes including incontinence, fall history, visual impairment, hearing impairment, constipation, chronic pain, sleeping disorder, dental problems, anxiety or depression, and delirium were more frequently in frail patients than in non-frail patients （P = 0.000, 0.031, 0.009, 0.014, 0.000, 0.003, 0.022, 0.000, 0.074, and 0.432, respectively）. Adjusted for sex, age, severity of coro- nary artery diseases （left main coronary artery lesion or not） and co-morbidities （CAD specific index） by Cox survival analysis, frailty was found to be strongly and independently associated with risk for the primary composite outcomes： all-canse mortality [Hazard Ratio （HR） = 5.393; 95% CI： 1.477-19.692, P = 0.011] and unscheduled return visit （HR - 2.832; 95% CI： 1.140-7.037, P = 0.025）. Conclusions Comprehensive Geriatrics Assessment and Clinical Frail Scale were useful in evaluation of elderly patients with ACS. Frailty was strongly and independently associated with short-term outcomes for elderly patients with ACS.

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

Background Many studies have indicated that medical therapy and percutaneous coronary intervention have similar effects in terms of the long-term prognosis of patients with stable coronary artery disease. This study investigated the effects of optimal medical therapy （OMT） and revascularization-plus-OMT in elderly patients with high-risk angina. Methods In this prospective non-randomized study, 241 consecutive high-risk elderly male patients （65-92 years of age） with angiographically confirmed multivessel disease were enrolled in the registry from January 2004 to April 2005. Of these, 98 patients underwent OMT and 143 underwent revascularization therapy plus OMT. Results After 6.5 years of follow-up, we found that the rate of long-term cardiac mortality was significantly higher in patients who under- went OMT than in those who underwent revascularization （6.5-year unadjusted mortality rate, 14.3% for OMT vs. 7.0% for revascularization patients; log-rank P = 0.04）. However, the overall risks of major adverse cardiac cerebrovascular events （MACCE） were similar among all patients （6.5-year unadjusted mortality rate, 29.6% for OMT vs. 27.3% for revascularization patients; log-rank P = 0.67）. Conclusions OMT was associated with an increase in cardiac death but a similar 6.5-year risk of MACCE compared with revascularization in high-risk elderly male patients with coronary multivessel disease.

不同剂量静脉丙种球蛋白对川崎病的治疗及随访分析

目的:观察不同剂量静脉丙种球蛋白(IVIG)治疗川崎病(KD)对冠状动脉病变(CAL)的影响,探讨IVIG最佳的治疗方案。方法:将81例住院KD患儿随机分为观察组和对照组,两组患儿在常规使用阿司匹林治疗的基础上,观察组40例予IVIG 1g/(kg·d)单次静脉滴注,5～6h滴完;对照组41例予IVIG 2g/(kg·d)单次静脉滴注,10～12h滴完。观察治疗过程中患儿的临床症状、体征、超声心动图、WBC、CRP、PLT、ESR的变化情况及对冠状动脉病变的随访。结果:两组患儿的退热时间、黏膜充血、皮疹消退、淋巴结肿大及手足肿胀等急性期临床症状恢复情况比较,差异无统计学意义(P>0.05)。治疗后与治疗前比较,两组患儿血WBC、PLT、CRP和ESR均显示明显降低;但两组上述指标相互比较差异无统计学意义(P>0.05)。观察组初诊CAL发生率为22.5%(9/40例),对照组为24.39%(10/41例),两组比较差异无统计学意义;病程1个月观察组CAL为4例(10%),对照组CAL为2例(4.88%),对照组CAL比观察组恢复快,但差异尚无统计学意义(P>0.05);随访6个月后,观察组CAL为1例(2.5%),对照组CAL为1例(2.44%),两组CAL恢复情况无差异。结论:应用IVIG 1g/kg和2g/kg治疗KD,均可有效控制急性期炎症反应,改善临床症状,对于冠状动脉病变的随访,应用IVIG 1g/kg和2g/kg的疗效在KD发病后2年内相似。但考虑到大剂量IVIG潜在的风险和经济因素,应用IVIG 1g/kg可能是治疗KD的最佳方案。

Effect of coronary artery revascularization on in-hospital outcomes and long-term prognoses in acute myocardial infarction patients with prior ischemic stroke

Objective To investigate whether coronary artery revascularization therapies （CART）, including percutaneous coronary intervention （PCI） and coronary artery bypass grafting （CABG）, can improve the in-hospital and long-term outcomes for acute myocardial infarction （AMI） patients with prior ischemic stroke （IS）. Methods A total of 387 AMI patients with prior IS were enrolled consecutively from January 15, 2005 to December 24, 2011 in this cohort study. All patients were categorized into the CART group （n = 204） or the conservative medications （CM） group （n = 183）. In-hospital cardiocerebral events and long-term mortality of the two groups after an average follow-up of 36 months were recorded by Kaplan-Meier survival curves and compared by Logistic regression and the Cox regression model. Results The CART patients were younger （66.5 ± 9.7 years vs. 71.7 ± 9.7 years, P 〈 0.01）, had less non-ST segment elevation myocardial infarction （11.8% vs. 20.8%, P = 0.016） and more multiple-vascular coronary lesions （50% vs. 69.4%, P = 0.031）. The hospitalization incidence of cardiocerebral events in the CART group was 9.3% while 26.2% in the CM group （P 〈 0.01）. CART significantly reduced the risk of in-hospital cardiocerebral events by 65% [adjusted odds ratio （OR） = 0.35, 95% CI： 0.13-0.92]. By the end of follow-up, 57 cases （41.6%） died in CM group （n = 137） and 24 cases （12.2%） died in CART group （n = 197）. Cox regression indicated that CART decreased the long-term mortality by 72% [adjusted hazard ratio （HR） = 0.28, 95% CI： 0.064）.46], while categorical analysis indicated no s{gnificant dif- ference between PCI and CABG. Conclusions CART has a significant effect on improving the in-hospital and long-term prognoses for AMI patients with prior IS.

Clinical Observation on Shu Xin Yi Mai Capsules for Prevention of Recurrent Stricture after Coronary Artery Introducing Treatment

Shu Xin Yi Mai Capsules (舒心益脉胶囊) combined with western medicine was used in the routine treatment of 22 cases who successfully received coronary artery introducing therapy (Chinese-western medicine group),and the results was compared with the 26 cases treated routinely with simple western medicine in the control group (western medicine group).It was found that both the recurrence rate of angina pectoris and the incidence rate of recurrent stricture in the Chinese-western medicine group were significantly lower than that in the control group (both P<0.05).There was no significant difference between the two groups in expression of platelet activating molecules CD62P (a-granular membrane protein),CD63 (lysosome intact membrane protein) and CD41 (glucoprotein IIb) before the treatment,but with a significant difference after the treatment (P<0.05).

Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

Background The coronary artery calcium （CAC） and aortic arch calcification （AoAC） are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of fol- low-up, 620 patients were treated by coronary stenting and 153 （7%） adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score 〈 400, AoAC showed an additive predictive value in detecting significant coronary artery disease （CAD）. A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays.

Retrospective analysis of percutaneous transluminal coronary angioplasty and coronary stenting

Objective To examine long term efficacy of percutaneous transluminal coronary angioplasty (PTCA),coronary stenting and to assess the factors affecting its efficacy Methods A total of 790 patients who underwent successful PTCA and PTCA+stent in this hospital were followed by direct interview or letter The rate of follow up was 84 2% and the period of follow up was 0 9-12 7 (3 5±2 4) years Results During follow up, 4 (0 5%) patients died, 22 (2 8%) had nonfatal acute myocardial infarction, 10 (1 3%) had coronary artery bypass surgery, and 98 (12 4%) had repeat PTCA The rate of recurrent angina pectoris was 31 1% The cardiac event free survival rate calculated by the Kaplan Meier method was 88 2% at 1 year and 80 6% at 12 7 years Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events Compared to the PTCA group, patients with PTCA+stent had significantly lower rates of total cardiac events Conclusion The long term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA+stent therapy should be the major treatment for revascularization in patients with coronary heart disease