Effect of cardiac rehabilitation care after coronary intervention on cardiac function recovery and negative mood in patients with myocardial infarction

BACKGROUND Cardiovascular disease,particularly myocardial infarction(MI)profound impact on patients'quality of life and places a substantial burden on the healthcare and economy systems.Developments in medical technology have led to the emer-gence of coronary intervention as an essential method for treating MI.AIM To assess the effects of cardiac rehabilitation care on cardiac function recovery and negative emotions in MI after coronary intervention.METHODS This study included a total of 180 patients with MI during the period from June 2022 to July 2023.Selected patients were divided into two groups:An observation group,which receiving cardiac rehabilitation care;a control group,which re-ceiving conventional care.By comparing multiple observation indicators such as cardiac function indicators,blood pressure,exercise tolerance,occurrence of adverse cardiac events,and negative emotion scores between the two groups of patients.All the data were analyzed and compared between two groups.RESULTS There were 44 males and 46 females in the observation group with an average age of 36.26±9.88 yr;there were 43 males and 47 females in the control group,with an average age of 40.87±10.5 yr.After receiving the appropriate postoperative nursing measures,the results of the observation group showed significant improvement in several indicators compared with the control group.Indicators of cardiac function,such as left ventricular end-diastolic internal diameter and left ventricular ejection fraction were significantly better in the observation group than in the control group(P<0.05).Exercise endurance assessment showed that the 6-minute walking test distance was significantly increased in the patients of the observation group(P<0.01).In addition,the incidence of adverse cardiac events was significantly lower in the observation group,and negative mood scores were significantly reduced(P<0.05).CONCLUSION Cardiac rehabilitation care after coronary intervention has a significant positive impact on functional recovery.This emphasizes the importance of cardiac rehabilitation care to improve patient recovery.

Meta-analysis of the impact of hyperuricemia on contrast agent-related acute kidney injury after percutaneous coronary intervention

Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases,and publish articles on the correlation between hyperuricemia and contrast agent-related acute kidney damage after percutaneous coronary intervention from the establishment of the database to August 162023.Two researchers independently conducted literature screening and data extraction to evaluate the bias risk of inclusion in the study,and conducted metaanalysis using Review Manager 5.4 software.Results:A total of 12 articles were included,including 11676 patients.The meta-analysis results showed that compared with patients without hyperuricemia,patients with hyperuricemia had a higher risk of developing PC-AKI,with an incidence rate of 22.3%.Hyperuricemia was a risk factor for the occurrence of PCAKI(OR=2.03,95%CI:1.58-2.61);Patients with hyperuricemia have a higher risk of death after PC-AKI,with a mortality rate of 7.5%.Hyperuricemia is a risk factor for early death in PC-AKI patients(OR=2.33,95%CI:1.81-3.00);The probability of CRRT treatment after PCAKI in patients with hyperuricemia is higher,at 3.14%.Hyperuricemia is an influencing factor for CRRT treatment in PC-AKI patients(OR=7,95%CI:2.83-17.30).Conclusion:Existing research evidence suggests that the presence of hyperuricemia is an independent risk factor for the occurrence of PC-AKI,and it significantly increases the hospital mortality rate and the risk of renal replacement therapy in PC-AKI patients.

A comparative study on transradial vs transfemoral artery access for primary percutaneous coronary intervention in patients with acute myocardial infarction

Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.

All roads lead to Rome——Direct cervical carotid artery access in carotid artery intervention

Carotid artery stenting (CAS) is an alternative treatment for patients with severe carotid artery stenosis, especially those with prohibitively high surgical risks.……

Feasibility of percutaneous coronary intervention via transulnar artery approachin selective patients with coronary heart disease

Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ±9.10 years)whose radial artery of right hand was thin with a weak pulse that was not suitable to transradial artery PCI while whose ulnar artery was thick with a strong pulse based on their larger diameter in ulnar artery as compared with those in radial artery ( 3.30 ±0.22mm vs 2.43 ±0.33 mm, P <0.05 ) by the investigation of vessel echography,but revesered Allen’s test for radial and ulnar artery was positive,were selected as the subjects for PCI TRU. The radio of ulnar artery versus radial artery was 1.35:1.00 and the time of Allen’s test in ulnar artery side was shorter than that in radial artery side ( 2.70 ±0.36 s vs 4.68 ±0.52s , P <0.05 ) before PCI. The efficiency of PCI TRU was evaluated. The time of manipulative duration for each procedure of PCI TRU was recorded. The time of Allen’s test, luminal diameter (mm) , cross area of vessel lumin (mm 2), blood velocity (Vs max), blood resistance (RI) in ulnar artery and radial artery and the level of blood oxygen in finger (PaO 2、SatO 2) were measured and recorded , respectively , as well were compared quantitatively before and after 1 month of procedure . Results Fourty eight lesion segments of 42 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter including 23 segments of type B1 , 14 segments of type B2 and 11 segments of type C. PCI TRU in all of 40 patients was performed successfully. Fourty eight stents were implanted including 2 lesions of intrastent restenosis angioplasticized with cutting balloon technique before re stenting . The average time of manipulative duration of guiding catheters engaging in osicum of target coronary, crossing the vessel lesions of guidewire, dilatation and implantation of stents,and under X ray fluoroscopy were 4.30 ±0.59 min , 2.52 ±0.40min , 2.66 ±0.40 min ,and 25.9 ±0.49 min , respectively, and the total time of the whole procedure was 56.6 ±14.8 min . When the ulnar introducer was taken off, the access site in ulnar artery was suppressed by tourniquet with no bleeding in the access site and no limitation of physical activation under maintaining infusion of heparin immediately after procedure . There was no significant change in the diameter of ulnar artery and the time of Allen’s test after 1 month of PCI procedure as compared with those before procedure ( 3.22 ±0.48mm vs 3.26 ±0.22 mm , P >0.05 ; 2.96 ±0.98 s vs 2.72 ±0.47 s , P >0.05 ). No significant change was found in the parameters of blood velocity , cross area of vessel lumin, blood resistance and the level of blood oxygen in finger after 1 month of PCI procedure. The average total hospital stay was 5.21 ±0.43 days. Following up 1 month, no complications such as occlusion of ulnar artery, abnormal sensitivity and movement disability were found in right hands in all patients.Conclusions The ulnar artery might be selected as one approach of antebrachial artery for PCI in the patients with coronary heart disease whose radial artery was difficulty as access vessels of PCI, while reversed Allen’s test for radial and ulnar artery are positive and the luminal diameter of ulnar artery was larger than that of radial artery.

Efficacy of Different Types of Self-expandable Stents in Carotid Artery Stenting for Carotid Bifurcation Stenosis

Both open and closed loop self-expandable stents were used in carotid artery stenting（CAS） for carotid bifurcation stenosis. We sought to compare the efficacy of two types of stents in CAS. The data of 212 patients treated with CAS（42 and 170 cases implanted with closed and open loop stents, respectively） for carotid bifurcation stenosis and distal filtration protection devices were retrospectively analyzed. Between closed and open loop stents, there were no significant differences in hospitalization duration, NIHSS score before and after the treatment, stenosis at 12 th month, and cumulative incidence of primary endpoint events within 30 days or from the 31 st day to the 12 th month; while there were significant differences in hemodynamic changes and rate of difficulty in recycling distal filtration protection devices. Use of open vs. closed loop stents for carotid bifurcation stenosis seems to be associated with similar incidence of complications, except for greater rate of hemodynamic changes and lower rate of difficulty in recycling the distal filtration protection devices.

Fatal complication, rescue therapy;covered stent for coronary artery perforation

Introduction: Although coronary perforation is a rare complication observed during intervenetional procedures, it has a considerably high mortality rate. The prevelance of coronary perforation has been reported to be 0.20%-0.6%. Its sudden development, the patient’s agitation and development of rapid collapse render intervention difficult. Materials and Method: The presence of perfusion balloon and covered stent in clinics is life-saving. In the present study, we retrospectively reviewed 17 cases with coronary artery perforation that were treated between 2009 and 2012. Of these patients, 10 (58.8%) were men and 7 (41.2%) were women;the median age was 62.8 ± 8.3 years. The coronary artery perforation resulted from guide wire in 23.5%, balloon dilatation in 58.8% and stent implantation in 17.6%. All the lesions were either type B or C lesions. Results: The extensiveness of perforation was Ellis grade I in 23.5%, grade II in 47.1% and grade III in 29.4% of the cases. In the treatment of the perforation, polytetrafluoroethylene-covered stent graft was implemented in 9 (52.9%) patients, whilst conventional and emergency surgical therapy was performed in 8 (47.1%) patients. Grade I perforations occurred due to the guide wire and were managed with conventional therapy (p < 0.05). Grade II and III perforations resulted from balloon and stent. The majority of these patients were inserted Graft Stent (stent graft in 52.9% and conventional therapy in 23.5% of the cases (p < 0.05). Although all the stent grafts were successfully implanted, the complete control of bleeding was achieved only in 77.7% of the patients. Mortality was not observed in grade I perforation, whilst all cases resulted in mortality had grade III perforation. Conclusion: These data indicate that there is a need for further advanced technology in the coronary artery perforation despite of currently available therapeutic options.

SUCCESSFUL TREATMENT OF CORONARY ARTERY PERFORATION WITH EMERGENCY INTRACORONARY COATED STENT IMPLANTATION

Coronary artery perforation is a rare but catatrophic complication of percutaneous coronary intervention.We report a case of type Ⅲ coronary artery perforation following stenting at calcified mid-segment of left anterior descending artery.The perforation was successfully covered using a PTFE-coated stent with an excellent clinical and angiographic outcomes.

The Evaluation of the Safety and Efficacy of Transradial Coronary Procedures

Objectives To evaluate the safety and efficacy of transradial coronary procedures （TRCP）. Methods The data of 83 cases who accepted transradial coronary angiography （CAG） and transradial percutaneous coronary intervention （PCI） in our department were summarized. The success rates, proximal coronary complications, peripheral vascular complications, severe vagal reflex, mean operation time （MOT）, mean recumbent time （MRT）, mean hospital-staying time （MHT） were analyzed. The data were compared with that of 420 cases of transfemoral coronary procedures （TFCP） in the same period. Results Success rates and proximal coronary complications were similar in both groups. Severe vagal reflexes were less in TRCP group than in TFCP group. MOT was longer in TRCP group. MRT and MHT were shorter in TRCP group. 12（14.5%） radial artery spasm, 3（3.6%） radial artery obstruction, 1 sudden respiratory arrest caused by jugular hematoma were observed in TRCP group. Conclusions The efficacy and safety of TRCP are definite. TRCP is more economical. For the purpose of properly evaluate the peripheral vascular complications of TRCP, it is necessary to pay special attention to radial artery occlusion, radial artery stenosis, and jugular hematoma.

Comparison of coronary artery bypass surgery and percutaneous coronary intervention in patients with diabetes:A meta-analysis of randomised controlled trials

Background The choice between coronary artery bypass surgery （CABG） and percutaneous coronary intervention （PCI） for revascularisation in patients with diabetes and multivessel coronary artery disease, who account for 25% of revascularisation procedures, is much debated. We aimed to assess whether all-cause mortality differed be- tween patients with diabetes who had CABG or PCI by doing a systematic review and meta-analysis of ran- domised controlled trials （RCTs） comparing CABG with PCI in the modem stent era.

Effect of the baseline HbA1c on the MACEs in patients with coronary artery disease after percutaneous coronary intervention

Background The present studies evaluated the association between admission glucose and adverse outcomes of people with coronary artery disease（CAD） after primary percutaneous coronary intervention（PCI）, but the effects of glucose control levels on these patients＇ outcomes are not fully studied, and the prognostic value of hemoglobin A1c（Hb A1c） for a better survival is still uncertain. Methods Our study included 440 patients with CAD undergoing the PCI therapy after admission, and who were divided into 2groups, one had Hb A1 c ≤ 6.5%（n = 309）, the other 〉 6.5%（n = 131）. Then, we gave these patients clinical follow-ups at the first, third, sixth, twelfth month respectively after PCI. Results There were no significant differences between the two groups at the baseline characteristics and the drugs taken by the patients after PCI. But we found that the outcomes of major adverse cardiac events（MACEs） were significantly better in Hb A1 c ≤6.5% group than in Hb A1 c 〉 6.5% group（P = 0.016） according to the COX multivariate regression analysis. Conclusion The MACE-free survival after PCI is significantly better when Hb A1 c is≤ 6.5% than Hb A1 c is 〉 6.5%.

Effects of different therapies on coronary artery disease

Objective To analyse the effects of different therapies on coronary artery disease (CAD).Methods A total of 1055 patients who suffered from CAD diagnoised by coronary angiograpy were divided into three groups, namely pure drug therapy, percutanious coronary intervention (PCI) and coronary artery bypass graft (CABG) groups. Follow up was carried out from March to May in 2001, and the major adverse cardiac events (MACEs) including death, no-lethal myocardial infarction (Ml) and revascularization were observed. In long-term observation, angina reoccured, and their improvement was evaluated. The short-term period was defined as the duration of 30 days after discharge, and the long term period was defined as the duration from 30 days after discharge.Results In the long-term period, the recurrences of angina both in PCI group and CABG group were lower than pure drug group (PO. 018, 0. 002 respectively). No differences about long-term endpoint events were observed among these three groups ( P > 0. 05). Forty-two patients suffering from left main coronary disease were intervened by the three therapies, and there was no death or Ml both in PCI and CABG groups, three patients died and suffered from AMI in pure drug therapy group (P = 0.015). In the short-term period, mortality in CABG group (5.77%) was higher than those in the other two groups (1.91% for PCI, and 1.40% for medical therapy, P = 0.002), and no obvious difference observed in the latter two groups. No significance was concluded about the recent Ml among this three groups (P = 0. 357). There were no differences on revascularization in these three groups.Conclusions Percutanious coronary interventions can not only reduce the attack of angina but also improve the life quality of patients, however it can not improve the long-term existance but left main CAD.