Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject...Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.展开更多
Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November ...Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.展开更多
The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients w...The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after steming or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was eXPressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 = absence of activity. The scores of scanning before stenting or intravenous throm-bolysis was SBS. The scores of scaning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the steming group and thrombolysis group: SBS was 41.3+9.8 and 39.4+7.9 (t=1.2, p <0.05); SAS was 17.8+6.4 and 27.3+6.7 (t=5.8, p <0.01); SDS was 24.5+4.2 and 12.2+2.3 (t = 7.3, P <0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after steming. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between steming group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p <0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis.展开更多
In-stent thrombosis(IST)is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization laboratory.This is a case of an 81-year-old man who presented with ST-...In-stent thrombosis(IST)is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization laboratory.This is a case of an 81-year-old man who presented with ST-elevation myocardial infarction.Right coronary artery(RCA)occlusion was suspected.RCA angiography and percutaneous coronary intervention were performed.Complicated left coronary artery disease was subsequently discovered.Per cardiothoracic surgeon request,the patient was transitioned from ticagrelor to clopidogrel therapy in preparation for coronary artery bypass grafting.The patient experienced IST the day before surgery while receiving clopidogrel.We examine this case,which highlights the complexity of antiplatelet therapy choice and the role of genetic testing in evaluation of IST risk.展开更多
目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且...目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且符合入组标准的患者共183例,随机分为尿激酶组（n=91）和对照组（n=92）。尿激酶组除常规介入治疗外,在支架植入术前经抽吸导管单次或继之在PCI术中反复多次给予5-10万U尿激酶,对照组不给予尿激酶。主要观察指标包括两组患者在PCI术后即刻的TIMI血流分级、校正TIMI帧数,心电图ST段回落,以及PCI术后7、30d左室功能情况。记录30d随访的主要不良心血管事件（MACEs,包括死亡、心绞痛、靶血管再次血运重建、心衰、脑卒中）。结果尿激酶组患者在PCI术后即刻的TIMIⅢ级血流及校正TIMI帧数明显优于对照组（83 vs 71,P=0.034;21.2±10.7 vs 29.6±15.3,P=0.012）,术后90min ST段回落〉70%患者百分比明显高于对照组（93.4%vs 82.6%,P=0.025）。术后7d随访时心脏超声左室射血分数（LVEF）改善不明显（53.5%±9.4%vs 51.6%±8.7%,P=0.158）,30d时心脏超声显示,尿激酶组LVEF明显优于对照组（56.3%±9.8%vs 53.5%±8.1%,P=0.036）。30d时尿激酶组MACEs发生率明显低于对照组（4.4%vs 13.0%,P=0.038）。结论急诊PCI术中于支架植入前单次或反复多次冠脉内给予小剂量尿激酶可有效增加心肌再灌注及左室功能,改善急性心肌梗死患者的短期预后,且安全性较好。展开更多
文摘Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.
文摘Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.
文摘The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after steming or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was eXPressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 = absence of activity. The scores of scanning before stenting or intravenous throm-bolysis was SBS. The scores of scaning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the steming group and thrombolysis group: SBS was 41.3+9.8 and 39.4+7.9 (t=1.2, p <0.05); SAS was 17.8+6.4 and 27.3+6.7 (t=5.8, p <0.01); SDS was 24.5+4.2 and 12.2+2.3 (t = 7.3, P <0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after steming. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between steming group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p <0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis.
文摘In-stent thrombosis(IST)is a rare yet dangerous complication that may occur despite optimized coronary intervention in the cardiac catheterization laboratory.This is a case of an 81-year-old man who presented with ST-elevation myocardial infarction.Right coronary artery(RCA)occlusion was suspected.RCA angiography and percutaneous coronary intervention were performed.Complicated left coronary artery disease was subsequently discovered.Per cardiothoracic surgeon request,the patient was transitioned from ticagrelor to clopidogrel therapy in preparation for coronary artery bypass grafting.The patient experienced IST the day before surgery while receiving clopidogrel.We examine this case,which highlights the complexity of antiplatelet therapy choice and the role of genetic testing in evaluation of IST risk.
文摘目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且符合入组标准的患者共183例,随机分为尿激酶组（n=91）和对照组（n=92）。尿激酶组除常规介入治疗外,在支架植入术前经抽吸导管单次或继之在PCI术中反复多次给予5-10万U尿激酶,对照组不给予尿激酶。主要观察指标包括两组患者在PCI术后即刻的TIMI血流分级、校正TIMI帧数,心电图ST段回落,以及PCI术后7、30d左室功能情况。记录30d随访的主要不良心血管事件（MACEs,包括死亡、心绞痛、靶血管再次血运重建、心衰、脑卒中）。结果尿激酶组患者在PCI术后即刻的TIMIⅢ级血流及校正TIMI帧数明显优于对照组（83 vs 71,P=0.034;21.2±10.7 vs 29.6±15.3,P=0.012）,术后90min ST段回落〉70%患者百分比明显高于对照组（93.4%vs 82.6%,P=0.025）。术后7d随访时心脏超声左室射血分数（LVEF）改善不明显（53.5%±9.4%vs 51.6%±8.7%,P=0.158）,30d时心脏超声显示,尿激酶组LVEF明显优于对照组（56.3%±9.8%vs 53.5%±8.1%,P=0.036）。30d时尿激酶组MACEs发生率明显低于对照组（4.4%vs 13.0%,P=0.038）。结论急诊PCI术中于支架植入前单次或反复多次冠脉内给予小剂量尿激酶可有效增加心肌再灌注及左室功能,改善急性心肌梗死患者的短期预后,且安全性较好。
