目的比较早期与晚期支架内血栓(ST)致4b型急性心肌梗死(AMI)患者院内及出院1年生存及预后情况。方法入选2015年1月—2018年2月冠状动脉造影确定ST致4b型AMI患者共302例。根据ST发生时间分为早期ST组(≤30 d)26例和晚期ST组(>30 d)276...目的比较早期与晚期支架内血栓(ST)致4b型急性心肌梗死(AMI)患者院内及出院1年生存及预后情况。方法入选2015年1月—2018年2月冠状动脉造影确定ST致4b型AMI患者共302例。根据ST发生时间分为早期ST组(≤30 d)26例和晚期ST组(>30 d)276例,对比2组患者住院期间及出院1年内的终点事件。主要研究终点包括心源性死亡和再发AMI;次要研究终点包括靶病变血运重建(TLR)、再次ST、心力衰竭及卒中。采用Kaplan-Meier法绘制生存曲线并比较2组患者无终点事件发生率;采用Cox回归分析4b型AMI患者发生终点事件的危险因素。结果住院期间2组主要研究终点事件发生率差异无统计学意义(7.7%vs.3.3%,P=0.243);早期ST组院内心力衰竭发生率高于晚期ST组(11.5%vs.1.4%,P=0.016),其他次要终点事件发生率差异无统计学意义(P>0.05)。平均随访1年,早期ST组主要(20.0%vs.5.9%,P<0.05)及次要(36.0%vs.11.5%,P<0.05)研究终点事件发生率均高于晚期ST组。Kaplan-Meier生存分析表明,早期ST组1年累积无主要(P=0.022)及次要(P<0.001)终点事件发生率均低于晚期ST组。Cox回归分析表明高血压、冠状动脉旁路移植术史是4b型AMI患者发生主要终点事件的独立危险因素,术中植入主动脉内气囊泵(IABP)、缩短支架内血栓至球囊扩张(ST to B)时间是其发生次要终点事件的独立保护因素。结论与晚期ST致4b型AMI患者相比,早期ST患者院内结局相似,长期预后差。术中植入IABP、缩短ST to B时间可能改善4b型AMI患者预后。展开更多
背景:冠脉旁路移植术常被认为是治疗冠状动脉粥样硬化性心脏病无保护左主干(unprotected left main coronary artery,ULMCA)病变的金标准疗法。近年来研究表明,药物洗脱支架在治疗ULMCA病变后的心血管不良事件发生率更低,甚至有研究者...背景:冠脉旁路移植术常被认为是治疗冠状动脉粥样硬化性心脏病无保护左主干(unprotected left main coronary artery,ULMCA)病变的金标准疗法。近年来研究表明,药物洗脱支架在治疗ULMCA病变后的心血管不良事件发生率更低,甚至有研究者认为药物洗脱支架将取代冠脉旁路移植术成新的为治疗金标准,但国内外学者对此尚有一定争议。目的:试验拟观察采用雷帕霉素药物洗脱支架植入治疗老年ULMCA病变的安全性和有效性,并与冠脉旁路移植术治疗进行比较。方法:纳入十堰市太和医院(湖北医药学院附属医院)心内科和十堰市人民医院(湖北医药学院附属医院)心内科收治的老年退行性ULMCA病变患者224例,按治疗方式的不同分为2组,支架组采用雷帕霉素药物洗脱支架植入治疗,冠脉旁路移植术采用冠脉旁路移植治疗,每组112例,术后随访9,12,24,36个月。研究中有效性的主要结局指标为术后36个月病变血管再次血运重建率。研究的次要结局指标为术后9,12,24个月病变血管再次血运重建率;术后9,12,24,36个月的血栓事件发生率、病变血管再狭窄率、病死率、死亡原因及生存时间。术前,术后9,12,24,36个月的病变血管的动脉造影形态。研究的安全性指标为术后9,12,24,36个月主要不良心脑血管事件发生率。课题组从2016年1月到2017年12月收集86例患者,分成支架组48例,冠脉旁路移植38例。预试验结果显示,与冠脉旁路移植组比较,支架组术前等待时间,术后住院时间及完全血运重建率均降低(P<0.05)。术后6个月,两组病死率、心肌梗死发生率、再次血运重建率及心脑血管不良事件发生率差异无显著性意义(P>0.05)。试验经十堰市太和医院和十堰市人民医院医学伦理委员会批准(审批单位:十堰市太和医院,审批时间2017年7月;审批号:TH005X;十堰市人民医院,审批时间2017年7月,审批号:RM011X)。研究符合世界医学会制定的《赫尔辛基宣言》的要求,研究对象均签署知情同意书。试验设计时间为2018年1月,试验计划于2018年8月开始进行患者招募,2019年8月招募结束,2022年10月进行结果指标分析,2022年12月试验完成。文章结果将以科学会议报道,或在同行评议的期刊上发表传播。试验已在中国临床试验注册中心注册(注册号:Chi CTR1800016413),方案版本号1.0。讨论:试验希望观察,雷帕霉素药物洗脱支架植入治疗老年ULMCA病变中长期随访有效性及安全性方面的数据与冠脉旁路移植术在相比,明确哪种疗法的预后效果更好,以筛选出治疗ULMCA病变最佳的策略。展开更多
Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regardi...Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regarding long-term outcomes. Methods: We identified 231 consecutive patients treated with drug-eluting stent implantation with the “crush”technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%. Results: The in-hospital major adverse cardiac event(MACE) rate was 5.2%. At 9 months, 10(4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization(TLR) was 90.3%; the only independent predictor of TLR was left main stem(LMS) therapy(odds ratio[OR] 4.97; 95%confidence interval[CI] 2.00 to 12.37, p=0.001). Survival free of MACE was 83.5%and independent predictors of MACE were LMS therapy(OR 3.79; 95%CI 1.76 to 8.14, p=0.001) and treatment of patients with multivessel disease(OR 4.21; 95%CI 0.95 to 18.56, p=0.058). Angiographic follow-up was obtained in 77%of lesions at 8.3±3.7 months. The mean late loss of the main vessel and side branch were 0.30±0.64 mm and 0.41±0.67 mm, respectively, with binary restenosis rates of 9.1%and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss(0.24±0.50 mm vs. 0.58±0.77 mm, p< 0.001). Conclusions: The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.展开更多
Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent covera...Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent coverage with DES implantations in single coronary lesions. We evaluated the data from 99 consecutive patients treated with extensive DES coverage, defined as ≥50 mm(mean 63.3±13.2, range 50 to 115), and a concurrent series of 466 patients with ≤24-mm DES length(mean 18.4±3.8, range 8 to 24). The periprocedural, 1-, and 6-month outcomes were compared between the 2 groups. The baseline characteristics were mostly comparable between the 2 groups, and procedural and in-hospital outcomes were similar. Although the incidence of death and myocardial infarction at follow-up were comparable, the combined end points of target lesion revascularization plus MACEs at 6 months occurred more often with extensive stent coverage. Multivariate analysis revealed stent length to be the only independent predictor of target lesion revascularization plus MACEs. Patients treated with extensive DES coverage had similar procedural success, major in-hospital complications, and death and myocardial infarction at follow-up, but had more combined adverse events because of an overall higher target lesion revascularization rate.展开更多
文摘目的比较早期与晚期支架内血栓(ST)致4b型急性心肌梗死(AMI)患者院内及出院1年生存及预后情况。方法入选2015年1月—2018年2月冠状动脉造影确定ST致4b型AMI患者共302例。根据ST发生时间分为早期ST组(≤30 d)26例和晚期ST组(>30 d)276例,对比2组患者住院期间及出院1年内的终点事件。主要研究终点包括心源性死亡和再发AMI;次要研究终点包括靶病变血运重建(TLR)、再次ST、心力衰竭及卒中。采用Kaplan-Meier法绘制生存曲线并比较2组患者无终点事件发生率;采用Cox回归分析4b型AMI患者发生终点事件的危险因素。结果住院期间2组主要研究终点事件发生率差异无统计学意义(7.7%vs.3.3%,P=0.243);早期ST组院内心力衰竭发生率高于晚期ST组(11.5%vs.1.4%,P=0.016),其他次要终点事件发生率差异无统计学意义(P>0.05)。平均随访1年,早期ST组主要(20.0%vs.5.9%,P<0.05)及次要(36.0%vs.11.5%,P<0.05)研究终点事件发生率均高于晚期ST组。Kaplan-Meier生存分析表明,早期ST组1年累积无主要(P=0.022)及次要(P<0.001)终点事件发生率均低于晚期ST组。Cox回归分析表明高血压、冠状动脉旁路移植术史是4b型AMI患者发生主要终点事件的独立危险因素,术中植入主动脉内气囊泵(IABP)、缩短支架内血栓至球囊扩张(ST to B)时间是其发生次要终点事件的独立保护因素。结论与晚期ST致4b型AMI患者相比,早期ST患者院内结局相似,长期预后差。术中植入IABP、缩短ST to B时间可能改善4b型AMI患者预后。
文摘背景:冠脉旁路移植术常被认为是治疗冠状动脉粥样硬化性心脏病无保护左主干(unprotected left main coronary artery,ULMCA)病变的金标准疗法。近年来研究表明,药物洗脱支架在治疗ULMCA病变后的心血管不良事件发生率更低,甚至有研究者认为药物洗脱支架将取代冠脉旁路移植术成新的为治疗金标准,但国内外学者对此尚有一定争议。目的:试验拟观察采用雷帕霉素药物洗脱支架植入治疗老年ULMCA病变的安全性和有效性,并与冠脉旁路移植术治疗进行比较。方法:纳入十堰市太和医院(湖北医药学院附属医院)心内科和十堰市人民医院(湖北医药学院附属医院)心内科收治的老年退行性ULMCA病变患者224例,按治疗方式的不同分为2组,支架组采用雷帕霉素药物洗脱支架植入治疗,冠脉旁路移植术采用冠脉旁路移植治疗,每组112例,术后随访9,12,24,36个月。研究中有效性的主要结局指标为术后36个月病变血管再次血运重建率。研究的次要结局指标为术后9,12,24个月病变血管再次血运重建率;术后9,12,24,36个月的血栓事件发生率、病变血管再狭窄率、病死率、死亡原因及生存时间。术前,术后9,12,24,36个月的病变血管的动脉造影形态。研究的安全性指标为术后9,12,24,36个月主要不良心脑血管事件发生率。课题组从2016年1月到2017年12月收集86例患者,分成支架组48例,冠脉旁路移植38例。预试验结果显示,与冠脉旁路移植组比较,支架组术前等待时间,术后住院时间及完全血运重建率均降低(P<0.05)。术后6个月,两组病死率、心肌梗死发生率、再次血运重建率及心脑血管不良事件发生率差异无显著性意义(P>0.05)。试验经十堰市太和医院和十堰市人民医院医学伦理委员会批准(审批单位:十堰市太和医院,审批时间2017年7月;审批号:TH005X;十堰市人民医院,审批时间2017年7月,审批号:RM011X)。研究符合世界医学会制定的《赫尔辛基宣言》的要求,研究对象均签署知情同意书。试验设计时间为2018年1月,试验计划于2018年8月开始进行患者招募,2019年8月招募结束,2022年10月进行结果指标分析,2022年12月试验完成。文章结果将以科学会议报道,或在同行评议的期刊上发表传播。试验已在中国临床试验注册中心注册(注册号:Chi CTR1800016413),方案版本号1.0。讨论:试验希望观察,雷帕霉素药物洗脱支架植入治疗老年ULMCA病变中长期随访有效性及安全性方面的数据与冠脉旁路移植术在相比,明确哪种疗法的预后效果更好,以筛选出治疗ULMCA病变最佳的策略。
文摘Objectives: The purpose of this studywas to evaluate predictors of an adverse outcome after “crush”bifurcation stenting. Background: The “crush”technique is a recently introduced strategy with limited data regarding long-term outcomes. Methods: We identified 231 consecutive patients treated with drug-eluting stent implantation with the “crush”technique for 241 de novo bifurcation lesions. Clinical follow-up was obtained in 99.6%. Results: The in-hospital major adverse cardiac event(MACE) rate was 5.2%. At 9 months, 10(4.3%) patients had an event consistent with possible post-procedural stent thrombosis. Survival free of target lesion revascularization(TLR) was 90.3%; the only independent predictor of TLR was left main stem(LMS) therapy(odds ratio[OR] 4.97; 95%confidence interval[CI] 2.00 to 12.37, p=0.001). Survival free of MACE was 83.5%and independent predictors of MACE were LMS therapy(OR 3.79; 95%CI 1.76 to 8.14, p=0.001) and treatment of patients with multivessel disease(OR 4.21; 95%CI 0.95 to 18.56, p=0.058). Angiographic follow-up was obtained in 77%of lesions at 8.3±3.7 months. The mean late loss of the main vessel and side branch were 0.30±0.64 mm and 0.41±0.67 mm, respectively, with binary restenosis rates of 9.1%and 25.3%. Kissing balloon post-dilation significantly reduced the side branch late lumen loss(0.24±0.50 mm vs. 0.58±0.77 mm, p< 0.001). Conclusions: The crush technique of bifurcation stenting with drug-eluting stents is associated with favorable outcomes for most lesions; however, efficacy appears significantly reduced in LMS bifurcations, and further research is needed before the technique can be routinely recommended in this group. Furthermore, the incidence of possible stent thrombosis is of concern and requires further investigation. Kissing balloon post-dilatation is mandatory to reduce side branch restenosis.
文摘Longer stent length has remained associated with the incidence of major adverse cardiac events(MACEs) in the drug-eluting stent(DES) era; therefore, we aimed to determine clinical outcomes after extensive stent coverage with DES implantations in single coronary lesions. We evaluated the data from 99 consecutive patients treated with extensive DES coverage, defined as ≥50 mm(mean 63.3±13.2, range 50 to 115), and a concurrent series of 466 patients with ≤24-mm DES length(mean 18.4±3.8, range 8 to 24). The periprocedural, 1-, and 6-month outcomes were compared between the 2 groups. The baseline characteristics were mostly comparable between the 2 groups, and procedural and in-hospital outcomes were similar. Although the incidence of death and myocardial infarction at follow-up were comparable, the combined end points of target lesion revascularization plus MACEs at 6 months occurred more often with extensive stent coverage. Multivariate analysis revealed stent length to be the only independent predictor of target lesion revascularization plus MACEs. Patients treated with extensive DES coverage had similar procedural success, major in-hospital complications, and death and myocardial infarction at follow-up, but had more combined adverse events because of an overall higher target lesion revascularization rate.
