Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

Prolonged dual antiplatelet therapy after drug-eluting stent implantation improves long-term prognosis for acute coronary syndrome:five-year results from a large cohort study

BACKGROUND:To investigate the most appropriate dual antiplatelet therapy(DAPT)duration for patients with acute coronary syndrome(ACS)after drug-eluting stent(DES)implantation in the largest cardiovascular center of China.METHODS:We enrolled 5,187 consecutive patients with ACS who received DES from January to December 2013.Patients were divided into four groups based on DAPT duration:standard DAPT group(11-13 months,n=1,568)and prolonged DAPT groups(13-18 months[n=308],18-24 months[n=2,125],and>24 months[n=1,186]).Baseline characteristics and 5-year clinical outcomes were recorded.RESULTS:Baseline characteristics were similar across the four groups.Among the four groups,those with prolonged DAPT(18-24 months)had the lowest incidence of major adverse cardiovascular and cerebrovascular events(MACCEs)(14.1%vs.11.7%vs.9.6%vs.24.2%,P<0.001),all-cause death(4.8%vs.3.9%vs.2.1%vs.2.6%,P<0.001),cardiac death(3.1%vs.2.6%vs.1.4%vs.1.9%,P=0.004),and myocardial infarction(MI)(3.8%vs.4.2%vs.2.5%vs.5.8%,P<0.001).The incidence of bleeding was not different among the four groups(9.9%vs.9.4%vs.11.0%vs.9.4%,P=0.449).Cox multivariable analysis showed that prolonged DAPT(18-24 months)was an independent protective factor for MACCEs(hazard ratio[HR]0.802,95%confidence interval[CI]0.729-0.882,P<0.001),all-cause death(HR 0.660,95%CI 0.547-0.795,P<0.001),cardiac death(HR 0.663,95%CI 0.526-0.835,P<0.001),MI(HR 0.796,95%CI 0.662-0.957,P=0.015),and target vessel revascularization(HR 0.867,95%CI 0.755-0.996,P=0.044).Subgroup analysis for high bleeding risk showed that prolonged DAPT remained an independent protective factor for all-cause death and MACCEs.CONCLUSION:For patients with ACS after DES,appropriately prolonging the DAPT duration may be associated with a reduced risk of adverse ischemic events without increasing the bleeding risk.

Efficacy and safety of individually tailored antiplatelet therapy in patients with acute coronary syndrome after coronary stenting： a single center, randomized, feasibility study

Background Low responsiveness to clopidogrel （LRC） is associated with increased risk of ischemic events. This study was aimed to explore the feasibility of tailored antiplatelet therapy according to the responsiveness to clopidogrel. Methods A total of 305 clopidogrel naive patients with acute coronary syndromes （ACS） undergoing coronary stenting were randomly assigned to receive standard （n = 151） or tailored （n = 154） antiplatelet therapy. The ADP-induced platelet aggregation tests by light transmission aggregometry were performed to identify LRC patients assigned to the tailored group. The standard antiplatelet regimen was dual antiplatelet therapy with aspirin and clopidogrel. The tailored antiplatelet therapy was standard regimen for non-LRC patients and an additional 6-month cilostazol treatment for LRC patients. The primary efficacy outcome was the composite of cardiovascular death, myocardial infarction or stroke at one year. Results LCR was present in 26.6% （41/154） of patients in the tailored group. The percentage platelet aggregation for LCR patients was significantly decreased at three days after adjunctive cilostazol treatment （77.5% ± 12.1% vs. 64.5% ± 12.1%, P 〈 0.001）. At one year follow-up, a non-significant 37% relative risk reduction of primary events were observed in the tailored group as compared to the standard group （5.8% vs. 9.3%, P = 0.257）. There were no differences in the rates of stent thrombosis and hemorrhagic events between the two groups. Conclusions Tailored antiplatelet therapy for ACS patients after coronary stenting according to responsiveness to clopidogrel is feasible. However, its efficacy and safety need further confirmation by clinical trials with larger sample sizes.

Is dual therapy the correct strategy in frail elderly patients with atrial fibrillation and acute coronary syndrome?

Atrial fibrillation(AF)is a very common arrhythmia in clinical practice.Its incidence and prevalence are age-related and are growing in the last years.Age is a risk factor also for coronary artery disease(CAD),and with the evolution of preventive care,the first event(acute coronary syndrome(ACS)or percutaneous coronary intervention(PCI))takes place at a later age.If elderly patients with AF and CAD undergo ACS or PCI,they have indication to assume triple therapy.Triple therapy(oral anticoagulation(OAC)plus dual antiplatelet therapy(DAPT))exposes patients to high bleeding risk.In the last 10 years,several clinical trials have tested dual therapy(OAC plus single antiplatelet therapy)in AF patients who undergo ACS or elective PCI.WOEST trial has tested warfarin+clopidogrel against triple therapy.PIONEER AF-PCI trial has tested low-dose rivaroxaban+P2Y12 inhibitor or very low-dose rivaroxaban+DAPT against standard triple therapy with warfarin.RE-DUAL PCI trial has tested two doses of dabigatran+P2Y12 inhibitor against standard triple therapy with Warfarin.AUGUSTUS trial has tested apixaban against warfarin both in dual therapy with P2Y12 inhibitor and in triple therapy with a P2Y12 inhibitor and aspirin.ENTRUST-AF PCI,last published study,has tested edoxaban+P2Y12 inhibitor against triple therapy.All these trials show dual therapy reduces significantly bleeding risk than triple therapy.In this paper,we analyze these clinical trials to understand if dual therapy results can be applied to elderly patients and what is probably the better approach in elderly AF patients undergo to ACS or PCI.

Antiplatelet therapy in very elderly and comorbid patients with acute coronary syndromes

With population ageing and rise of life expectancy,a progressively increasing proportion of patients presenting with an acute coronary syndrome(ACS)are older adults,including those at extreme chronological age.Increasing amounts of data,including randomized clinical trials,have shown that the benefits of an early revascularization are maintained also at very old age,resulting in improved outcome after an acute coronary event.On the contrary,the optimal antiplatelet therapy(APT)remains unclear in these patients,because of both safety and efficacy concerns.Indeed,age-related multiple organ dysfunction and high prevalence of comorbidities may on the one hand reduce the therapeutic effects of administered drugs;on the other hand,it leads to increased vulnerability to drug toxicity and side effects.Therefore,management of APT is particularly challenging in elderly patients because of higher risk of both ischemic and bleeding events.The aim of the present paper is to review the current evidence,gaps in knowledge and ongoing research regarding APT in the setting of an ACS in elderly and very elderly patients,and in those with significant comorbidities including chronic kidney disease,diabetes mellitus and frailty.

Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

Objective The optimal antithrombotic regimen for patients on oral anticoagulation （OAC） after acute coronary syndrome （ACS） and percutaneous coronary intervention （PCI） remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world setting. Methods We retrospectively analyzed data from an international, multi-center registry be- tween 2003 and 2014 （n = 15,401）. Patients with ACS and receiving OAC after PCI were screened. The composite primary endpoint was 1-year all-cause death, re-infarction, or severe bleeding. Results The final analysis enrolled 642 patients including 62 patients （9.7%） with OAC and clopidogrel （dual therapy）, and 580 patients （90.3%） with the combination of aspirin, OAC and clopidogrel （triple therapy）. Pa- tients on triple therapy were more often female and were more likely to have comorbidities. There was no significant difference regarding the primary end point between dual therapy with triple therapy patients [17.74% vs. 17.24%; unadjusted hazard ratio （HR）： 1.035; 95% confi- dence interval （CI）： 0.556-1.929; adjusted HR： 1.026; 95% CI： 0.544-1.937]. However, the re-infarction rate was significantly higher in dual therapy than triple therapy patients （14.52% vs. 5.34%; unadjusted HR： 2.807; 95% CI： 1.329-5.928; adjusted HR： 2.333; 95% CI： 1.078-5.047）. In addition, there was no difference between two regimes in all-cause death and severe bleeding. Conclusions In real-life patients with ACS following PCI and with an indication of OAC, triple therapy was not associated with an increased rate of adverse out- comes compared to dual therapy. Moreover, it decreased risk of re-infarction and did not increase risk of severe bleeding.

Risk Factors for Gastrointestinal Injuries in Acute Coronary Syndrome Patients with Double Antiplatelet Therapy in One-Year Follow-Up

Background: The goal is to determine the incidence of symptomatic gastrointestinal (GI) injuries in acute coronary syndrome (ACS) patients receiving double antiplatelet therapy (DAPT). The risk factors for serious GI complications are also evaluated. Methods: 603 eligible patients from the Department of Cardiology at Zhongda Hospital between January 2014 and August 2015 were enrolled and the occurrence of GI injuries within one year assessed. The risk factors for serious GI complications were identified using cox regression analysis. Results: After one-year follow-up, 108 (17.9%) out of 603 patients developed symptomatic GI injuries: 22 (3.65%) with serious GI complications and 86 (14.2%) with GI symptoms. Drinking habit (95% CI: 1.512 - 8.796;P = 0.004) and previous peptic injury (95% CI: 2.307 - 18.080;P = 0.001) are independent predictors of serious GI complications, while proton pump inhibitor (PPI) was protective (95% CI: 0.120 - 0.699;P = 0.006) per cox regression analysis. Additionally, GI injuries of both serious GI complications and GI symptoms peaked in the first three months. Conclusions: Symptomatic GI injuries were relatively common in ACS patients with DAPT, especially in the first three months. Previous peptic injury and drinking habit were significant independent risk factors for serious GI complications, while PPI played a protective role in ACS with DAPT.

Fondaparinux:A cornerstone drug in acute coronary syndromes

In acute coronary syndrome(ACS),the use of anticoagulants in conjunction with antiplatelet agents in the acute phase has resulted in reduced ischemic events and is more effective than either class of drug used alone.Though parenteral anticoagulation is essential at the time of diagnosis,a balance must be made between ischemic benefit and the increased risk of bleeding when prescribing anticoagulants.Adverse events associated with anticoagulants,such as heparin-induced thrombocytopenia,bleeding problems,and the need for close monitoring of anticoagulant activity,have contributed to finding agents that reduce these limitations.Studies like the Organization to Assess Strategies in Ischemic Syndromes 5 and 6 and their meta-analysis have proven the efficacy of Fondaparinux over the entire ACS spectrum.The convenience of administration(once daily),lack of monitoring,reduction in mortality,and better safety profile make Fondaparinux a simple and effective anti-coagulant for the management of ACS.

In-hospital outcome of elderly patients with acute coronary syndromes treated with platelet glycoproteinⅡb/Ⅲa blockers

Background and objective The safety of intravenous glycoproteinⅡb/Ⅲa inhibitors (GPI) in elderly patients admitted with acute coronary syndrome (ACS) has not yet been established. The purpose of this study was to evaluate the safety of GPI in elderly patients with ACS. Methods Ninety consecutive patients≥70 years of age admitted to a county hospital between 1999-2004 were included. All patients had typical ACS symptoms along with high-risk markers. Results There was no difference in the TIMI risk score between patients who received GPI (n=47) and those who did not (n=43). Patients who received GPI had a lower creatinine clearance (40 cc/min vs. 47cc/min, p= 0.04). Patients who received GPI had a lower incidence of death, reinfarction or major bleeding (19% vs. 4%, p=0.03). There was no significant difference in major bleeding between the 2 groups. None of the patients in either group developed thrombocytopenia. Conclusion This retrospective small study suggests that the use of GPI in a selected group of elderly patients with acute coronary syndrome may be safe. (J Geriatr Cardiol 2005; 2(4):203-205 )

De-escalation of anti-platelet therapy in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a narrative review

Objective:Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor inhibitor is the cornerstone of treatment in patients with acute coronary syndromes (ACS) and in those undergoing percutaneous coronary intervention (PCI).In current clinical situation, availability of different oral P2Y12 inhibitors (clopidogrel, prasugrel, and ticagrelor) has enabled physicians to switch among therapies owing to specific clinical scenarios.Although optimum time, loading dose and interval of transition between P2Y12 inhibitors is still controversial and needs further evidence, switching between oral inhibitors frequently occurs in clinical practice for several reasons.Data sources:This review was based on data in articles published in PubMed up to June 2018, with the following keywords "antiplatelet therapy" , "ACS" , "PCI" , "ticagrelor" and "clopidogrel" .Study selection:Original articles and critical reviews on de-escalation strategy in ACS patients after PCI were selected.References of the retrieved articles were also screened to search for potentially relevant papers.Results:Safety concerns associated with switching between antiplatelet agents, has prompted the use of clopidogrel for patients with ACS especially after PCI as a de-escalation strategy.Practical considerations for de-escalating therapies in patients with ACS such as reducing dose of P2Y12 inhibitors or shortening duration of DAPT (followed by aspirin or P2Y12 receptor inhibitor monotherapy) as potential options are yet to be standardized and validated.Conclusions:Current review will provide an overview of the pharmacology of common P2Y12 inhibitors, definitions of deescalation and different de-escalating strategies and its outcomes, along with possible direction to be explored in de-escalation.

Situation of antithrombotic therapy in elderly patients with atrial fibrillation and acute coronary syndrome

Background Atrial fibrillation is the most common cardiac arrhythmia in clinical practice. The study examines the situation of antithrombotic therapy in elderly patients （more than 60 years old） with non-valvular atrial fibrillation （NVAF） and acute coronary syndrome （ACS） / percutaneous coronary intervention （PCI）. Methods This study enrolled 381 elderly patients Emean age （69.95 ± 8.41） years; 289 males, 92 femalesl with NVAF and ACS/PCI between January 2006 and September 2013. According to clinical data, these patients were categorized into 4 groups： triple therapy （TT） group, dual antiplatelet therapy （DAT） group, vitamin K antagonist （VKA） plus single antiplatelet therapy （SAT） group and VKA group. According to score of CHA2DS2-VASc and HAS-BLED, all the patients were divided into 4 combinations. Statistical methods were used to analyze the situation of antithrombotic therapy and potential associations between the different combinations. Results 38 patients （9.97%） received TT and 300 patients （78.74%） received DAT. TT was received in 20 patients with CHA2DS2-VASc ≥2 and HAS-BLED ≥3, and 16 patients with CHA2DS2- VASc≥2 and HAS-BLED 〈 3. Conclusions Elderly patients who suffered NVAF and ACS/PCI were with high risk of stroke and low risk of bleeding. Majority of these patients received DAT instead of TT.

替格瑞洛递减联合尼可地尔对老年急性冠脉综合征PCI术后干预的有效性和安全性

目的探索老年急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后替格瑞洛递减治疗与尼可地尔联合干预的有效性和安全性。方法纳入2016年11月-2019年6月于解放军总医院第六、第七医学中心及北京朝阳中西医结合急诊抢救医院诊治的300例老年ACS患者,男153例,女147例,年龄>65岁,所有患者均接受PCI治疗,均为双联抗血小板治疗(DAPT)评分≥2分,新型DAPT评分(PRECISE-DAPT)≥25分的老年患者。所有患者术前采用随机数字表法分为替格瑞洛组(n=146,给予替格瑞洛180 mg负荷剂量后行PCI,术后给予替格瑞洛90 mg bid)与替格瑞洛递减+尼可地尔组(n=154,给予替格瑞洛180 mg负荷剂量后行PCI,术后给予替格瑞洛90 mg bid+尼可地尔5 mg tid,6个月后改为替格瑞洛60 mg bid+尼可地尔5 mg tid)。随访12个月。观察两组患者12个月内出现的心血管死亡、心肌梗死、卒中的复合终点,PLATO研究定义轻微出血、次要出血、其他主要出血和主要致命/危及生命的出血的复合终点,以及心血管死亡、心肌梗死、卒中与出血的复合终点。结果两组患者一般基线资料比较差异均无统计学意义(P>0.05);两组心血管死亡、心肌梗死、卒中的复合终点差异无统计学意义(P>0.05)。而替格瑞洛递减+尼可地尔组出血事件的累积发生率明显低于替格瑞洛组(P<0.05);心血管死亡、心肌梗死、卒中与出血事件的复合终点也明显低于替格瑞洛组(P<0.05)。结论老年ACS患者PCI术后替格瑞洛递减+尼可地尔治疗可不增高心血管死亡、心肌梗死及卒中等缺血性事件的发生率,且可降低出血性事件的发生率。

基于AGREEⅡ的急性冠脉综合征患者抗血小板药物治疗的指南评价

目的:采用临床指南研究与评估系统Ⅱ(AGREEⅡ)工具,对2010—2019年国内外公开发表的急性冠脉综合征(ACS)患者抗血小板药物治疗相关临床实践指南进行方法学评价。方法:选取2010—2019年国内外公开发表的ACS患者抗血小板药物治疗指南及相关文献为研究对象,使用AGREEⅡ对其进行系统评价,并分析各指南推荐内容的差异。结果:共纳入相关文献10篇,其中7篇治疗指南,3篇专家建议与共识。AGREEⅡ各领域的平均得分,范围和目的为(82.5±8.7)%,参与人员为(67.5±15.3)%,制定的严谨性为(68.7±18.2)%,表达的清晰性为(89.3±4.0)%,应用性为(68.1±13.8)%,编辑的独立性为(54.8±12.3)%,总体评价为(65.7±12.3)%。组内相关系数及95%CI为0.89(0.72~0.92),说明研究员评分一致性较高。指南均推荐术后使用阿司匹林+P2Y12受体拮抗剂双联抗血小板治疗。结论:临床实践指南用药推荐术后使用阿司匹林+P2Y12受体拮抗剂双联抗血小板治疗,用药疗程为12个月。ACS患者非必要无需进行基因检测。

A Comparative Study on Post-intervention Use of Tirofiban or Enoxaparin in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Objectives To evaluate the efficacy and safety of post procedure use of platelet glycoprotein Ⅱb/Ⅲ a receptor in- hibitor （PGI） or low molecular weight heparin （LMWH） in patients with acute coronary syndrome （ACS） undergoing dual anti-platelet loading therapy and percutaneous coronary intervention （PCI）. Methods This was a prospective randomized grouping controlled study in 174 patients with ACS received aspirin 300 mg plus clopidogrel 600mg loading before PCI. After procedure, patients were randomized to intravenous tirofiban for 12 -24 hours （tirofiban group） or subcutaneous enoxaparin for 5 days （enoxaparin group）. Cardiac ischemic events, major bleeding complications, minor bleeding complications, thrombocytopenia, and vascular access complications in both groups were investigated. Results Cardiac ischemic events, major bleeding complications, minor bleeding complications, thrombocytopenia, and vascular access complications in tirofiban group were 8.0% , 3.4% , 6.8% , 3.4% , and 3.4% , respectively. In enoxaparin group, aforementioned event rates were 7%, 2. 3%, 6. 0%, 2. 3%, and 5.8%, respectively. No statistical significance was found between two groups. Conclusions In the setting of dual anti-platelet medication loading and PCI for the treatment of ACS, it is effective to use tirofiban or enoxaparin for aggressive post procedure antithrombotic therapy. It comes with a very low major bleeding complication rate. Use of GPI for 12 to 24 hours was comparable to use of LMWH for 5 days in efficacy and safety.

血栓弹力图联合CYP2C19检测指导急性冠脉综合征患者经皮冠状动脉介入术术后抗血小板治疗的临床研究

目的探讨血栓弹力图(TEG)联合CYP2C19检测指导急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后抗血小板治疗的临床价值。方法选取2020年1月至2023年6月萍乡市人民医院行PCI的270例ACS患者作为研究对象,根据患者意愿分为A组(未行检查,n=115)、B组(CYP2C19基因检测,n=95)、C组(CYP2C19联合TEG检测,n=60)。其中A组患者常规给予阿司匹林联合氯吡格雷抗血小板、B组根据CYP2C19基因检测是否敏感分别给予阿司匹林联合氯吡格雷、阿司匹林联合替格瑞洛抗血小板治疗;C组根据基因检测及TEG检测结果分别给予阿司匹林联合氯吡格雷、阿司匹林联合氯吡格雷或替格瑞洛、阿司匹林联合替格瑞洛抗血小板治疗。PCI术后随访6个月,比较三组出血事件、主要不良心血管事件(MACE)、药物不良反应。结果三组的出血事件发生率比较,差异无统计学意义(P>0.05);A组的MACE总发生率高于B组、C组,差异有统计学意义(P<0.017);三组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论TEG联合CYP2C19检测指导ACS患者PCI术后抗血小板治疗能减少MACE发生风险,具有较高的安全性。

高出血风险的急性冠状动脉综合征患者抗血小板治疗方案研究进展

冠状动脉内血栓形成是急性冠状动脉综合征(ACS)的主要病理基础,其中血小板活化、黏附和聚集是血栓形成的关键,所以抗血小板成为治疗过程中的重要一环。但抗血小板药物所带来的严重不良反应之一是增加了出血风险,而严重出血事件与ACS患者的高死亡率密切相关。如何权衡缺血与出血风险一直是临床工作中的难点,而由于高出血风险ACS患者的其特殊性,在抗血小板治疗时难以把控出血事件,因此这类人群抗血小板治疗方案的选择也更具有挑战性。

急性冠状动脉综合征降脂治疗的研究进展

急性冠状动脉综合征(ACS)是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征,对人类健康造成巨大影响。血脂异常尤其是低密度脂蛋白胆固醇在ACS发生发展中发挥重要作用。近年来降脂治疗在冠心病患者中的作用已得到公认,血脂控制越好,心血管事件发生率越低。目前,各国对冠心病尤其是ACS患者血脂管理提出了明确要求,并推荐阶梯式治疗策略。但即使采用了指南推荐的降脂治疗方案,ACS患者血脂达标率仍较低。因此,规范降脂药物的使用,探讨新的降脂策略作为指南推荐的降脂疗法的有效补充,从而为ACS患者制订个性化的治疗方案,将成为未来降脂治疗的新方向。

基层医院急性冠脉综合征患者药物治疗管理模式的建立

目的:探讨基层医院急性冠脉综合征(ACS)患者药物治疗管理模式的建立及效果评价。方法:结合基层医院现状创建ACS患者药物治疗管理模式。成立医师、药师联合管理团队,制订标准管理流程,对患者进行全程用药管理。比较标准管理模式和传统管理模式下患者关于药物治疗认知、用药依从性、危险因素控制、用药合理性等方面的差异。结果:标准管理模式下的患者药物治疗认知、用药依从性及血压、心率、血脂、血糖等指标达标率均高于传统管理模式患者;除“药物剂量过高”外,其他用药相关问题发生率均低于传统管理模式患者(均P<0.05)。结论:基层医院开展药物治疗管理可提高ACS患者的用药依从性及危险因素达标率,减少不合理用药,建议在基层医院推广。

老年急性冠状动脉综合征合并心力衰竭介入术后早期应用沙库巴曲缬沙坦的疗效研究

目的探讨老年急性冠状动脉综合征合并心力衰竭介入术后早期应用沙库巴曲缬沙坦的效果。方法80例老年急性冠状动脉综合征合并心力衰竭患者,采用随机数表法划分为对照组和研究组,每组40例。两组均行经皮冠状动脉介入术,对照组术后予以马来酸依那普利片治疗,研究组术后予以沙库巴曲缬沙坦治疗。比较两组氨基末端脑钠肽前体水平,心功能[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)、左心室短轴缩短率(LVFS)],临床疗效,死亡率和再住院率。结果两组患者治疗后的氨基末端脑钠肽前体水平较治疗前降低,其中研究组氨基末端脑钠肽前体(3714.26±188.31)ng/L比对照组的(4107.69±203.51)ng/L更低(P<0.05)。两组患者治疗后的LVEF、LVFS水平较治疗前升高,LVEDD水平较治疗前降低,其中研究组LVEF(45.31±5.01)%、LVFS(35.41±6.33)%高于对照组的(40.21±6.59)%、(29.84±4.19)%,LVEDD(47.63±5.36)mm低于对照组的(53.11±5.47)mm(P<0.05)。研究组治疗总有效率92.50%较对照组的75.00%更高(P<0.05)。研究组死亡率0比对照组的2.50%低,但组间无差异(P>0.05);研究组再住院率2.50%明显低于对照组的17.50%(P<0.05)。结论在急性冠状动脉综合征合并心力衰竭患者介入术后早期予以沙库巴曲缬沙坦进行治疗,可改善心功能,降低氨基末端脑钠肽前体水平,同时也能提高治疗效果,降低死亡和再住院风险,值得推广应用。

经皮冠状动脉介入治疗2022年度临床研究进展

近年来,我国的经皮冠状动脉介入治疗(PCI)规范化管理取得了很大进步。胸痛中心建设无疑是ST段抬高型心肌梗死的一种非常有效的救治模式。对非ST段抬高型急性冠状动脉综合征患者在入院时进行危险分层是合理应用介入策略和改善临床预后的前提。PCI已广泛用于高危患者(高龄、急性冠状动脉综合征、心力衰竭或内科合并症等)和各种复杂冠状动脉病变(左主干、冠状动脉慢性完全闭塞、严重钙化等)的治疗,并可达到与冠状动脉旁路移植术相同的临床疗效。冠状动脉内影像和功能学评估的应用,使更多的冠状动脉病变获得更精准的介入治疗。介入操作技能的改进和新技术的开展,以及术后抗血小板的正确使用,显著提高了特殊复杂病变PCI的成功率和远期疗效。本文对2022年PCI临床研究进展做一简要的回顾。