Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention （PCI）. Methods This study evaluated the in-hospital procedural characteristics...Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention （PCI）. Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Aus- tralian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octoge- narians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin （LMWH; 1.0% vs. 5.8%; P 〈 0.001） and glycopro- tein IIb/IIIa inhibitors （2.1% vs. 9.6%; P 〈 0.001） was lower, while femoral arterial access was used more commonly than in younger patients （80.9% vs. 67.6%; P 〈 0.001）. Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly （9.2% vs. 5.8%; P = 0.12）. There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.展开更多
Percutaneous transluminal renal artery stenting （PTRAS） has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis （ARAS）. Whether PTRAS could improve left ven-...Percutaneous transluminal renal artery stenting （PTRAS） has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis （ARAS）. Whether PTRAS could improve left ven- tricular hypertrophy （LVH） and reduce adverse events when based on percutaneous coronary intervention （PCI） for patients with coronary artery disease （CAD） and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction （HFpEF）. A total of 228 patients meeting inclusion criteria were divided into two groups： （1） the HFpEF-I group, with PCI and PTRAS; （2） the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index （LVMI） and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure （SBP） was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.展开更多
Objective：There are a great number of modified models based on the four-vessel occlusion（4VO）model of Pulsinelli and Brierley which has been used worldwide for brain ischemia research.However,up to now the problems...Objective：There are a great number of modified models based on the four-vessel occlusion（4VO）model of Pulsinelli and Brierley which has been used worldwide for brain ischemia research.However,up to now the problems of collateral circulations of 4VO and the difficulty in arranging a surgery to occlude the basilar artery in other models are not satisfactorily solved yet.In this study,an improved 4-vessel occlusion（I4VO）rat model which is easy to handle and able to decrease the effect of collateral circulation is reported.Methods：The common carotid arteries and the beginning of the subclavical arteries of rats were occluded for different time by one-stage apertura thoracis superior approach.Neurological deficit scores defined by the modified Garcia scoring system and histopathological method were used to evaluate the effects of this model up to 7 days after reperfusion.Results：The neurological scores in the 15-min and 25-min groups decreased significantly at 24,48 and 72 hours after reperfusion（P〈0.05）,and the histopathologic study showed that there were stable,symmetrical changes of lesions in bilateral hippocampus in all the ischemia samples from two ischemia groups compared with sham operated group（P〈0.05）.Conclusion：This modified model is safe,easy,reliable,stable,mini-invasive as well as time-saving in making bilateral hemispheric ischemia,which can effectively decrease collateral circulations and meanwhile lead to stable lesions in hippocampus and cortex.展开更多
文摘Background Octogenarians constitute an increasing proportion of patients presenting for non-emergency percutaneous coronary intervention （PCI）. Methods This study evaluated the in-hospital procedural characteristics and outcomes, including the bleeding events of 293 octogenarians presenting between January 2010 and December 2012 for non-emergency PCI to a single large volume tertiary care Aus- tralian center. Comparisons were made with 293 consecutive patients aged less than or equal to 60 years, whose lesions were matched with the octogenarians. Results Non-ST elevation myocardial infarction was the most frequent indication for non-emergency PCI in octoge- narians. Compared to the younger cohort, they had a higher prevalence of co-morbidities and more complex coronary disease, comprising more type C and calcified lesions. Peri-procedural use of low molecular weight heparin （LMWH; 1.0% vs. 5.8%; P 〈 0.001） and glycopro- tein IIb/IIIa inhibitors （2.1% vs. 9.6%; P 〈 0.001） was lower, while femoral arterial access was used more commonly than in younger patients （80.9% vs. 67.6%; P 〈 0.001）. Overall, there was a non-significant trend towards higher incidence of all bleeding events in the elderly （9.2% vs. 5.8%; P = 0.12）. There was no significant difference in access site or non-access site bleeding and major or minor bleeding between the two cohorts. Sub-analysis did not reveal any significant influence on bleeding rates by the use of LMWH, glycoprotein IIb/IIIa inhibitors or femoral arterial access. In addition, there were no significant differences in the rates of in-hospital mortality, stroke or acute stent thrombosis between the two groups. Conclusions In this single center study, we did not observe significant increases in adverse in-hospital outcomes including the incidence of bleeding in octogenarians undergoing non-emergency PCI.
基金Project supported by the Guangdong Provincial Scientific Grant(No.2013B031800024),China
文摘Percutaneous transluminal renal artery stenting （PTRAS） has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis （ARAS）. Whether PTRAS could improve left ven- tricular hypertrophy （LVH） and reduce adverse events when based on percutaneous coronary intervention （PCI） for patients with coronary artery disease （CAD） and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction （HFpEF）. A total of 228 patients meeting inclusion criteria were divided into two groups： （1） the HFpEF-I group, with PCI and PTRAS; （2） the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index （LVMI） and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure （SBP） was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.
文摘Objective：There are a great number of modified models based on the four-vessel occlusion（4VO）model of Pulsinelli and Brierley which has been used worldwide for brain ischemia research.However,up to now the problems of collateral circulations of 4VO and the difficulty in arranging a surgery to occlude the basilar artery in other models are not satisfactorily solved yet.In this study,an improved 4-vessel occlusion（I4VO）rat model which is easy to handle and able to decrease the effect of collateral circulation is reported.Methods：The common carotid arteries and the beginning of the subclavical arteries of rats were occluded for different time by one-stage apertura thoracis superior approach.Neurological deficit scores defined by the modified Garcia scoring system and histopathological method were used to evaluate the effects of this model up to 7 days after reperfusion.Results：The neurological scores in the 15-min and 25-min groups decreased significantly at 24,48 and 72 hours after reperfusion（P〈0.05）,and the histopathologic study showed that there were stable,symmetrical changes of lesions in bilateral hippocampus in all the ischemia samples from two ischemia groups compared with sham operated group（P〈0.05）.Conclusion：This modified model is safe,easy,reliable,stable,mini-invasive as well as time-saving in making bilateral hemispheric ischemia,which can effectively decrease collateral circulations and meanwhile lead to stable lesions in hippocampus and cortex.
