Unloading and successful treatment with bioresorbable stents during percutaneous coronary intervention:A case report

BACKGROUND With the development of percutaneous coronary intervention(PCI),the number of interventional procedures without implantation,such as bioresorbable stents(BRS)and drug-coated balloons,has increased annually.Metal drug-eluting stent unloading is one of the most common clinical complications.Comparatively,BRS detachment is more concealed and harmful,but has yet to be reported in clinical research.In this study,we report a case of BRS unloading and successful rescue.This is a case of a 59-year-old male with the following medical history:“Type 2 diabetes mellitus”for 2 years,maintained with metformin extended-release tablets,1 g PO BID;“hypertension”for 20 years,with long-term use of metoprolol sustained-release tablets,47.5 mg PO QD;“hyperlipidemia”for 20 years,without regular medication.He was admitted to the emergency department of our hospital due to intermittent chest pain lasting 18 hours,on February 20,2022 at 15:35.Electrocardiogram results showed sinus rhythm,ST-segment elevation in leads I and avL,and poor R-wave progression in leads V1–3.High-sensitivity troponin I level was 4.59 ng/mL,indicating an acute high lateral wall myocardial infarction.The patient’s family requested treatment with BRS,without implanta-tion.During PCI,the BRS became unloaded but was successfully rescued.The patient was followed up for 2 years;he had no episodes of angina pectoris and was in generally good condition.CONCLUSION We describe a case of a 59-year-old male experienced BRS unloading and successful rescue.By analyzing images,the causes of BRS unloading and the treatment plan are discussed to provide insights for BRS release operations.We discuss preventive measures for BRS unloading.

Synchronous carotid endarterectomy and coronary artery bypass graft: Four case reports

BACKGROUND One of the major perioperative complications for coronary artery bypass graft(CABG)is stroke.The risk of perioperative stroke after CABG is approximately 2%.Carotid stenosis(CS)is considered an independent predictor of perioperative stroke risk in CABG patients.The optimal management of such patients has been a source of controversy.One of the possible surgical options is synchronous carotid endarterectomy(CEA)and CABG.Here,we have presented 4 cases of successful synchronous CEA and CABG.Our center’s experience with 4 cases of significant carotid artery stenosis,which were successfully managed with combined CEA and CABG,are detailed.The first case was a female who presented for CABG after a ST-elevation myocardial infarction.She had right internal carotid artery(ICA)occlusion and 90%left ICA stenosis.The second case was a male who was electively admitted for CABG.It was discovered that he had left ICA occlusion and 90%right ICA stenosis.The third case was a male with a history of stroke,two months prior to admission.He presented with non-ST-elevation myocardial infarction.Preoperatively,it was discovered that he had>90%right ICA stenosis.The final case was a male who was electively admitted for CABG.It was discovered that he had bilateral>90%ICA stenosis.We have also reviewed the current evidence and guidelines for managing CS in patients undergoing CABG.CONCLUSION Our case series demonstrated that synchronous CEA and CABG was safe.A multicenter study with additional patients is needed.It is necessary for clinicians to screen for CS in high-risk patients with features.

Coronary artery aneurysms caused by Kawasaki disease in an adult:A case report and literature review

BACKGROUND Kawasaki disease(KD) is a self-limiting febrile illness and an acute vasculitis with an unknown origin.It predominantly affects children aged < 5 years.KD is the common cause of acquired heart disease in children.We here report a case of KD in an asymptomatic young female patient diagnosed with multiple coronary aneurysms with calcification.CASE SUMMARY A 29-year-old female patient admitted to Hangzhou First People’s Hospital with coronary artery abnormality identified for 1 wk.The patient was asymptomatic;however,chest computed tomography occasionally revealed strip-like dense shadows in the coronal sulcus.After coronary angiography and Doppler echocardiography,the final diagnosis was coronary artery aneurysms(CAAs) caused by KD.Although the patient was asymptomatic with no history of KD in childhood,the definitive diagnosis was CAAs caused by KD.The patient was administered anticoagulant,and surgical treatment was recommended.CONCLUSION KD potentially causes CAAs in 25% of untreated cases,primarily occurring in the proximal portions of the coronary arteries.

Argumentative Comparative Analysis of Machine Learning on Coronary Artery Disease

Cardiovascular disease (CVD) is a leading cause of death across the globe. Approximately 17.9 million of people die globally each year due to CVD, which comprises 31% of all death. Coronary Artery Disease (CAD) is a common type of CVD and is considered fatal. Predictive models that use machine learning algorithms may assist health workers in timely detection of CAD which ultimately reduces the mortality. The main purpose of this study is to build a predictive model that provides doctors and health care providers with personalized information to implement better and more personalized treatments for their patients. In this study, we use the publicly available Z-Alizadeh Sani dataset which contains random samples of 216 cases with CAD and 87 normal controls with 56 different features. The binary variable “Cath” which represents case-control status, is used the target variable. We study its relationship with other predictors and develop classification models using the five different supervised classification machine learning algorithms: Logistic Regression (LR), Classification Tree with Bagging (Bagging CART), Random Forest (RF), Support Vector Machine (SVM), and K-Nearest Neighbors (KNN). These five classification models are used to investigate the detection of CAD. Finally, the performance of the machine learning algorithms is compared, and the best model is selected. Our results indicate that the SVM model is able to predict the presence of CAD more effectively and accurately than other models with an accuracy of 0.8947, sensitivity of 0.9434, specificity of 0.7826, and AUC of 0.8868.

Spontaneous coronary dissection should not be ignored in patients with chest pain in autosomal dominant polycystic kidney disease:A case report

BACKGROUND When autosomal dominant polycystic kidney disease(ADPKD)presents with acute coronary syndrome(ACS),the possibility of spontaneous coronary artery dissection(SCAD)should be highly considered.In some cases,SCAD is considered an extrarenal manifestation of ADPKD depending on the pathological characteristics of the unstable arterial wall in ADPKD.CASE SUMMARY Here,we report a 46-year-old female patient with ADPKD who presented with ACS.Coronary angiography revealed no definite signs of dissection,while intravascular ultrasound revealed a proximal to distal dissection of the left circumflex.After a careful conservative medication treatment,the patient exhibited favorable prognosis.CONCLUSION In cases of ADPKD co-existing with ACS,differential diagnosis of SCAD should be considered.Moreover,when no clear dissection is found on coronary angiography,IVUS should be performed to prevent missed diagnosis.

Drug-coated balloons for treating de novo lesions in large coronary vessels:A case report

BACKGROUND Percutaneous transluminal coronary angioplasty,while an effective intervention,can frequently lead to acute occlusion with severe consequences.Although clinical trials have demonstrated the efficacy of drug-coated balloons(DCB)in treating acute coronary artery occlusion and in preventing restenosis,there has been limited exploration on the use of DCB in treating de novo lesions in large vessels.Currently,DCB are only recommended for patients with small vessel lesions and in-stent restenosis lesions,those at high risk of bleeding,and other special groups of patients.CASE SUMMARY This report presents a case of successful drug-coated balloon treatment of de novo lesions in large coronary vessels.Postoperatively,the patient demonstrated favorable recovery,with subsequent examination results revealing no significant differences from the previous examination.CONCLUSION The successful treatment of the patient in our case highlights the potential of DCB in the treatment of de novo lesions in large coronary vessels.

基于CAD-RADS的高危斑块特征联合CT-FFR对冠状动脉临界病变预后的预测价值

目的:研究基于冠状动脉疾病报告和数据系统(coronary artery disease-reporting and data system,CAD-RADS)的高危斑块特征联合CT血流储备分数(fractional flow reserve derived from CT,CT-FFR)对冠状动脉病临界病变患者预后的临床应用价值。方法:在CAD-RADS结构式报告基础上,前瞻性研究冠状动脉CT血管造影(coronary artery CT angiography,CCTA)影像资料和临床资料,共301例临界病变患者纳入研究,影像观察指标包括CAD-RADS≥3、钙化积分≥100、斑块易损性特征、高危斑块、长病变、CT-FFR≤0.8,观察指标的组合包括CAD-RADS≥3 V、CAD-RADS≥3 V且CT-FFR≤0.8。研究终点为预后不良,包括主要不良心血管事件(major adverse cardiovascular events,MACE)及计划外有创冠状动脉造影(invasive coronary angiography,ICA)、血运重建手术,研究样本分为预后良好组和预后不良组。通过统计不同组间数据的差异,评价CAD-RADS高危斑块联合CT-FFR对临界病变患者预后的临床价值。结果:年龄、钙化积分、CAD-RADS类别、斑块易损性特征、高危斑块、长病变、CT-FFR在预后良好组和预后不良组间的差异有统计学意义(P<0.05);CAD-RADS类别、高危斑块、CT-FFR是冠状动脉临界病变预后的独立预测因子(P<0.05);CT-FFR≤0.8在CAD-RADS≥3组、钙化积分≥100组、不同斑块易损性特征组、高危斑块组、长病变组中发生率差异均有统计学意义(均P<0.05);观察指标组合(CAD-RADS≥3 V且CT-FFR≤0.8)预测预后不良的特异性、准确性和阳性预测值分别为97.2%、85.7%、88.7%,AUC为0.795(95%CI:0.731~0.858)。结论:基于CAD-RADS的高危斑块特征联合CT-FFR能有效预测MACE及计划外ICA、血运重建手术,指导临床针对性干预与治疗。

探究冠状动脉支架术后患者健康相关症状的异质性分类及预测因素

目的探讨冠状动脉支架术后患者的症状分布特征,并分析高症状负担人群的预测因素。方法于2023年3-5月采用便利抽样的方法,选取湖南省衡阳市某2所三级甲等综合医院接受冠状动脉支架术的366例冠心病患者为研究对象。使用患者报告结局测量信息系统(patient-repotred outcomes measurement information system,PROMIS)特征集进行调查,应用潜在类别分析(latent class analysis,LCA)、单因素分析、logistic回归分析确定术后患者症状的特征分类,并探索各类别的区分因素。结果LCA结果表明,冠状动脉支架术后患者的健康相关症状存在3个潜在类别,分别为高心理症状组(33%)、低症状组(48.1%)、高生理症状组(18.9%)。不同类别患者在身体功能、社会功能、疼痛强度上的差异有统计学意义(P<0.05)。年龄、文化程度、心功能水平、合并其他慢性病状况及支架植入个数是预测冠状动脉支架术后患者症状类别的重要因素(P<0.05)。结论冠状动脉支架术后患者存在3种类别的症状特征,照护时可依据区分3类别的预测因素对患者精准识别,有效管理。且3组患者的身体功能均有一定程度受限,以高生理症状组尤其明显;高心理症状组需重点关注其社会功能。

Out-of-hospital cardiac arrest in a young adult survivor with sequelae of childhood Kawasaki disease: A case report

BACKGROUND Kawasaki disease(KD)is an acute type of systemic vasculitis involving small to medium-sized muscular arteries and outbreaks during childhood.KD can cause myocardial ischemia,infarction,and sudden cardiac arrest.We present a case of a young adult survivor of out-of-hospital cardiac arrest as late KD sequelae.CASE SUMMARY A 29-year-old man with presumed acute KD history at the age of 5 suddenly lost consciousness while jogging and was diagnosed a sudden cardiac arrest by an emergency doctor.After about 10 min cardiopulmonary resuscitation,return of spontaneous circulation was achieved,and the patient was transferred to our hospital.A coronary computed tomography angiogram and coronary angiography revealed extensive calcifications of left anterior descending and right coronary artery aneurysms.The patient was an active individual who took exercise regularly and claimed no previous symptoms of chest pain or shortness of breath on exertion.The most possible cause of his sudden cardiac arrest could be presumed as a thrombus within the coronary artery aneurysms.After that,a thromboembolism induced extensive ischemia,and this ischemia-induced arrhythmia led to a cardiac arrest.CONCLUSION Few patients who suffer a late sequela of KD can survive from out-of-hospital cardiac arrest.Medications,surgical intervention,and active follow-up are extremely important for this patient to prevent occurrence of adverse events in the future.

Incomplete Kawasaki disease complicated with acute abdomen: A case report

Kawasaki disease(KD)is an acute systemic vasculitis characterized by unknown etiology.CASE SUMMARY A 4.5-year-old boy developed an acute abdomen during the onset of incomplete KD.He still had persistent abdominal pain after undergoing exploratory laparotomy and appendectomy.Ultrasound examination at early onset revealed a giant coronary artery aneurysm.The patient developed a myocardial infarction and heart failure accompanied by respiratory and cardiac arrest.He underwent coronary artery revascularization and coronary artery bypass graft using an autologous internal mammary artery.After the operation,the cardiac output increased,and the symptoms of heart failure resolved.Follow-up evaluation at 1 mo after operation showed that the patient's cardiac function had restored to New York Heart Association standard Grade I heart failure,and normal growth was obtained.CONCLUSION Coronary artery revascularization and coronary artery bypass graft is an effective method for treating myocardial ischemia in children with KD complicated with giant coronary artery aneurysm.Nevertheless,some issues still need specific attention.

Evaluation of intracoronary function after reduction of ventricular rate by esmolol in severe stenotic myocardial bridge: A case report

BACKGROUND Severe stenotic myocardial bridges(MBs)have been reported to lead to intracoronary ischaemia,but the physiological evaluation of MBs using intracoronary function evaluation indicators after intraoperative drug treatment has not been fully established.CASE SUMMARY We performed through snuff fossa for coronary angiography in a patient with chest tightness after repeated exercise,and the results showed that the middle part of the anterior descending branch was a MB with 100%systolic compression.The intracoronary function evaluation(defined as the ratio of distal coronary pressure to aortic pressure with zero microcirculation resistance)was instantaneous wave-free ratio(IFR)without drug and fractional flow reserve(FFR)with adenosine.The IFR was 0.73,and the FFR was 0.66.Then esmolol 0.02μg/kg/min was intravenously injected.The IFR and FFR were measured again when the heart rate dropped to 60 beats/min.The IFR was 0.83,and the FFR 0.65.CONCLUSION This case report is a case of isolated MB with severe stenosis.After intraoperative drug treatment decreased the ventricular rate,an increase in the coronary function evaluation index was immediately observed to confirm the effective improvement of coronary blood flow.

老年冠状动脉扩张患者和白细胞与平均血小板体积比值的相关性研究

目的研究老年冠状动脉扩张(coronary artery ectasia,CAE)患者和白细胞与平均血小板体积比值(WMR)的相关性。方法回顾性分析2018年1月1日至2023年1月1日天津市第一中心医院心内科接受冠状动脉造影(coronary angiography,CAG)的患者238例,根据CAG检查结果及年龄分为老年CAE组100例、非老年CAE组138例。根据CAG检查结果,选择同期年龄匹配的127例患者为老年冠状动脉正常组。检测所有患者WMR水平。结果老年CAE组WMR高于非老年CAE组和老年冠状动脉正常组[(745.50±237.46)vs(672.43±194.52)、(610.11±144.22),P=0.000]。Spearman相关性分析显示,WMR与血小板计数、中性粒细胞和高敏C反应蛋白呈正相关(r=0.380,P=0.000;r=0.819,P=0.000;r=0.283,P=0.000)。多因素logistic分析显示,再入院、男性、TC和WMR是老年CAE患者的独立危险因素(P<0.05,P<0.01)。WMR区分老年CAE患者的ROC曲线下面积为0.604(95%CI:0.531~0.677,P=0.006)。结论WMR升高有可能成为老年CAE患者中具有成本效益的监测指标。

ATP Stress Myocardial Contrast Echocardiography Assessment of Coronary Microvascular Disease with Spasmodic Characteristics: A Case Report

Here, a patient with chest pain and <50% stenosis on coronary angiography, where ATP stress myocardial contrast echocardiography (MCE) revealed that coronary flow reserve was reduced to 1.71 was presented. Perfusion delay occurred in the left ventricular wall of the apex of the heart before ATP stress, and the perfusion delay area was significantly reduced at peak stress. Similar to the characteristics of "reverse redistribution" of radionuclide myocardium perfusion in coronary vasospasm, the delayed perfusion area in the recovery period was larger than that detected before stress. Together with increased spectral resistance of the distal segment of left anterior descending coronary artery and chest pain, these findings indicated coronary microvascular disease with spasmodic characteristics in this patient. The perfusion characteristics on ATP stress determined by MCE and changes in coronary spectrum have value for the diagnosis and treatment of coronary microvascular disease with spasmodic characteristics.

冠状动脉疾病报告与数据系统在冠心病患者危险因素分析中的应用

目的:探讨冠状动脉疾病报告与数据系统(CAD-RADS)在冠状动脉粥样硬化性心脏病(冠心病)诊断中的应用及其危险因素,阐明危险因素对CAD-RADS诊断冠心病的影响强度。方法:收集266例临床怀疑冠心病患者的冠状动脉CT血管造影(CTA)影像资料和临床相关资料,采用CAD-RADS分级法将患者分为冠心病组(n=174)和非冠心病组(n=69)。分析2组患者年龄、性别、高血压、高血脂、糖尿病、吸烟、尿酸(UA)水平和血浆纤维蛋白原(FIB)水平;采用单因素和多因素Logistic回归分析方法分析CAD-RADS系统诊断冠心病的相关危险因素。结果:与非冠心病组比较,冠心病组患者中男性、高血压、糖尿病和吸烟者所占比例明显升高(P<0.05),冠心病组患者平均年龄大、UA水平高(P<0.05)。多因素Logistic回归分析,年龄和糖尿病是冠状动脉CAD-RADS诊断冠心病的最显著危险因素。结论:CAD-RADS诊断冠心病受到多种危险因素的影响,其中年龄和糖尿病是最显著的独立相关危险因素。

针灸治疗冠心病临床选穴规律的数据挖掘研究

目的研究针灸治疗冠状动脉粥样硬化性心脏病(冠心病)临床选穴规律。方法从CNKI、万方、维普、PubMed数据库收集1991-2013年针灸治疗冠心病的临床文献,建立冠心病选穴数据库,对数据进行统计描述、关联规则分析和聚类分析。结果 1991-2013年每年论文发表的数量无显著性差异,使用频率最高的腧穴依次为内关、心俞、膻中;相关性最高的腧穴是内关-心俞;临床选穴符合冠心病的病因病机特点;根据聚类分析结果,这些腧穴可分为重点穴和选配穴两大类。结论针灸治疗冠心病有规律可循,根据文献分析所发现的组方规律与该病的病机、病证相符,为针灸治疗冠心病的临床选穴提供了参考。

冠状动脉疾病报告和数据系统——CAD-RADS^(TM)简介

冠状动脉CTA是冠状动脉疾病的首选影像检查方法,且在冠状动脉疾病管理中发挥重要的作用。冠状动脉疾病报告和数据系统(CAD-RADS^(TM))是由多个行业协会共同发布的专家共识,其目的是使冠状动脉CTA报告标准化,以利于临床推广、普及和处理决策的制定。本文主要介绍CAD-RADS^(TM)指南的内容。

系统心理干预对冠状动脉搭桥术患者焦虑抑郁的影响

目的探讨系统心理护理干预对冠状动脉搭桥术(CABG)患者的影响。方法将102例行CABG患者随机分为对照组和观察组各51例。两组术前均予常规治疗与护理,观察组在此基础上给予系统心理护理干预,内容包括满足患者需求、增强抗病信心,个体化的心理疏导,分散患者注意力、深化患者角色等。采用焦虑自评量表(SAS)和抑郁自评量表(SDS)对患者于入院时、术前1d、术后3d、术后5d进行调查,统计SAS、SDS评分和住院时间。结果观察组术前1d、术后3d、术后5dSAS、SDS评分及阳性率分别与入院时比较,差异有显著性意义(P<0.01,P<0.05);与对照组同时段比较,差异有显著性意义(P<0.01,P<0.05)。结论CABG患者存在明显的焦虑、抑郁心理,系统心理护理干预可明显改善其焦虑、抑郁情绪。

解读国际心血管CT协会“CAD-RADS冠状动脉病变报告和数据系统”

随着CT技术的飞速发展,冠状动脉CT血管成像(CCTA)的应用越来越普遍,CCTA诊断报告的影像学术语和评价内容的标准化成为迫切需要解决的问题。对国际心血管CT协会的冠状动脉病变报告和数据系统(CAD-RADS)进行深入解读,学习其标准化的影像学术语和评价内容,有助于为临床提供更多、更明确的信息,指导医生制定下一步诊疗计划,甚至更好地评估治疗方案对病人预后的影响。

冠心病与牙周炎的相关性调查

目的探讨牙周炎与冠心病的相互关系。方法选择大庆油田总医院心内科冠心病患者161例(冠心病组),162名无冠心病史的社区居民作为对照组。两组均行问卷调查及牙周病检查,比较两组的牙周状况及牙槽骨丧失的差异,并对冠心病可能的危险因素进行logistic回归分析。结果冠心病组患重度牙周炎比例明显高于对照组。冠心病组的平均牙槽骨水平、全口余留牙数量、深牙周袋数量、探诊出血百分比,与对照组比较差异均有统计学意义。Logistic回归分析显示重度牙周炎是影响冠心病的危险因素之一,OR值为5.74,95%可信区间为2.07～15.90。结论牙周炎与冠心病之间存在一定的相关性。

药物洗脱支架的应用现状和展望(英文)

学术背景:最新研究发现,内皮修复延迟可导致支架内血栓形成,目前一种既具有良好的抗再狭窄功效同时又具有血栓不易形成安全性的药物支架是人们研究的目标。目的:综述药物洗脱支架新近的研究进展,以及最新的临床应用试验,同时展望其未来的发展趋势和方向。检索策略:由该论文的研究人员应用计算机检索PUBMED2002-01/2007-04期间相关文献,检索词为"drug eluting stents,percutaneous coronary intervention,coronary disease",并限定文章语言种类为English。同时检索2005-01/2007-06因特网最新的相关国际会议报道。共检索到15篇文献,对资料进行初审,纳入标准:①有关药物支架的最新报道。②药物支架的最新研制进展。③药物支架的最新临床应用进展。排除标准:相关性低及重复性文章。文献评价:共收集到264篇药物洗脱支架研究和应用的文献,纳入42篇,同时纳入5篇相关性和时效性较强的会议报道。资料综合:理想的药物洗脱支架由支架平台,药物载体及药物三者协调构成。随着支架材料学和新型药物的开发,更加有效的支架应用于临床治疗中。最近,大量临床研究数据鼓励临床工作者将其应用于更多的挑战性冠脉病例,如慢性完全闭塞病变,多支血管病变等。然而,部分临床研究的结果使药物支架引起的晚期血栓而造成的支架安全性问题更加受到关注和重视。因此在药物支架的开发和应用中力求做到安全性和有效性的平衡。在新型的药物支架中,可降解支架,促进内皮愈合涂层支架更具发展前景。结论:药物洗脱支架是心脏介入治疗中的重大进展,它给冠心病的治疗带来了很多益处尤其是减少了再狭窄和再次血运重建,但随着对其远期疗效和安全性的重视,药物支架的研制将朝向高效低危发展。