Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.

Shortened dual antiplatelet therapy in contemporary percutaneous coronary intervention era

Percutaneous coronary intervention with stenting is followed by a duration of dual antiplatelet therapy(DAPT)to reduce stent thrombosis and avoid target lesion failure.The period of DAPT recommended in international guidelines following drug-eluting stent implantation is 12 mo for most patients with acute coronary syndrome,and 6 mo for patients with chronic coronary syndrome or high bleeding risk.The new generation of drug-eluting stents have metallic platforms with thinner struts,associated with significantly less stent thrombosis.Shortened DAPT has been investigated with these stents,with evidence from randomised clinical trials for some individual stents showing non-inferior safety and efficacy outcomes.This has to be balanced by the effect of DAPT on secondary prevention of systemic cardiovascular disease especially in high-risk populations.This review will outline the current evidence for individual stents with regards to DAPT duration for both acute coronary syndrome and chronic coronary syndrome and discuss further directions for research and personalised medicine in this contemporary percutaneous coronary intervention era.

Adequate antiplatelet regimen in patients on chronic anti-vitamin K treatment undergoing percutaneous coronary intervention

AIM: To investigate the impact of dual antiplatelet therapy (DAT) in patients on antivitamin K (AVK) regimen requiring percutaneous coronary intervention (PCI).METHODS: Between February 2006 and February 2008, 138 consecutive patients under chronic AVK treatment were enrolled in this registry. Of them, 122 received bare metal stent implantation and 16 received drug elutingstent implantation. The duration of DAT, on top of AVK treatment, was decided at the discretion of the clinician. Adequate duration of DAT was def ined according to type of stent implanted and to its clinical indication. RESULTS: The baseline clinical characteristics of patients reflect their high risk, with high incidence of comorbid conditions (Charlson score ≥ 3 in 89% of the patients). At a mean follow-up of 17 ± 11 mo, 22.9% of patients developed a major adverse cardiac event (MACE): 12.6% died from cardiovascular disease and almost 6% had an acute myocardial infarction. Major hemorrhagic events were observed in 7.4%. Adequate DAT was obtained in only 44% of patients. In the multivariate analysis, no adequate DAT and Charlson score were the only independent predictors of MACE (both P = 0.02). CONCLUSION: Patients on chronic AVK therapy represent a high risk population and suffer from a high MACE rate after PCI. An adequate DAT regimen and absence of comorbid conditions are strongly associated with better clinical outcomes.

Comparative Nursing Study of Patients Undergoing Coronary Intervention Therapy in Different Ways

Purpose: To compare the surgical indicators, perioperative complications and postoperative psychological status of patients with coronary interventional therapy (CIT) by radical artery and femoral artery puncture approaches. Methods: 120 patients with CIT were divided into femoral artery group (FAG) and radial artery group (RAG) according to the operation ways. The interventional operation was performed by the same surgeon team and methods. Data of surgical indicators and perioperative complications were recorded and collected. The psychological questionare survey was made within 48 hours the after surgery by the hospital anxiety and depression scale (HAD), and the results were scored by the psychiatrist. Results: The age, sex, ethnicity, education level, disease type, and combined diseases of the two groups had homogeneity without statistical difference. There was no obvious difference in X-ray exposure time, contrast agent usage and operation time in two ways (P > 0.05). The success rate of one-time catheterization was higher in FAG than in RAG (P Conclusion: CIT via radial artery can reduce the incidence of postoperative complications, postoperative physical discomfort and psychological problems such as anxiety and depression of patients.

Rationale and Role of High Loading Dose Clopidogrel in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Antiplatelet therapy, which reduces platelet activation and aggregation, is the corner stone of treatment for patients undergoing percutaneous coronary intervention (PCI). Clopidogrel is an established oral antiplatelet medication of thienopyridine class, which inhibits blood clots in coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Many studies have revealed that high loading dose clopidogrel in patients undergoing PCI. This review article investigates the rationale and role of high loading dose clopidogrel in patients undergoing PCI.

Music therapy combined with motivational interviewing

BACKGROUND Percutaneous coronary intervention(PCI)is one of the main treatment methods for myocardial infarction(MI).Despite its positive effects,patients often experience different degrees of anxiety and depression after the intervention.Therefore,effectively changing the emotional state of patients with MI during PCI remains a focus of clinical research.AIM To assess the effect of music therapy and motivational interviewing in young and middle-aged patients with anxiety and depression after PCI.METHODS We collected data from January 2022 to December 2023 from 86 young and middle-aged patients with MI after PCI.They were divided into observation and control groups according to the random throwing method.The observation group consisted of 43 patients undergoing music therapy and motivational interviewing,and the control group(43 cases)underwent music therapy and conventional communication.The two groups were then compared on mood status[Chinese Brief Mood Status Scale(POMS)],coping methods[Medical Coping Methods Questionnaire(MCMQ)Chinese version],and healthy lifestyle behaviors[Heart Health Self-Efficacy and Self-Management(HH-SESM)scale].RESULTS Two weeks post-intervention,the observation group had lower POMS scores,improved MCMQ scores,and higher HH-SESM scores than the control group(P<0.05).CONCLUSION The combined intervention of music therapy and motivational interviewing for young and middle-aged patients with anxiety and depression after MI can effectively regulate their mood,reduce anxiety and depression symptoms,and stimulate patients to actively face their condition.It also encourages the formation of healthy behavioral habits.

静默疗法对经皮冠状动脉介入术患者心理应激反应及睡眠障碍的影响

目的评价静默疗法在经皮冠状动脉介入(PCI)术患者中的应用效果。方法选择2023年1月至2024年3月本院收住入院接受PCI术的100例患者为研究对象。对照组接受PCI术后常规护理,观察组在对照组的基础上采用静默疗法。两组患者干预周期均为4周,干预前后采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数量表(PSQI)调查患者心理应激反应程度及睡眠质量。结果干预前两组患者SAS、SDS、PSQI得分比较差异无统计学意义(P>0.05);干预后观察组SAS、SDS、PSQI得分低于对照组,差异有统计学意义(P<0.05)。结论将静默疗法应用于PCI术患者中,能降低患者心理应激反应程度及改善睡眠质量,建议护理人员积极推广应用。

Prognostic Analysis and an Appropriate Antiplatelet Strategy for Patients With Percutaneous Coronary Intervention and High Bleeding Risk:Rationale and Protocol for a MultiCenter Cohort Study

Percutaneous coronary intervention(PCI)is an important treatment strategy for patients with coronary artery disease.However,bleeding after PCI significantly increases the mortality risk.The search for prognostic predictors and optimal antiplatelet therapy for patients with high bleeding risk(HBR)after PCI has been a much researched upon topic in current cardiovascular research.However,there is no widely accepted prognostic model or recommended antiplatelet therapy for patients with PCI-HBR.In this trial,based on prospective multi-center database building,we will analyze the adverse prognostic predictors for patients with PCI-HBR,observe the types of antiplatelet drugs and duration of dual antiplatelet therapy in PCI-HBR patients,and compare the safety and feasibility of different antiplatelet regimens and treatment courses.The prognostic analysis and an appropriate antiplatelet strategy for patients with PCI and high bleeding risk(PPP-PCI)trial will help analyze bleeding risk factors in PCI-HBR patients and explore the appropriate antiplatelet treatment options.This study is registered with ClinicalTrials.gov(NCT05369442).The Research Ethics Committee of West China Hospital authorized this study(2022 Review#269).The trial results will be published in peer-reviewed journals and at conferences.

Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction： a multicenter randomized clinical trial

Background Although thrombolytic therapy with rescue percutaneous coronary intervention （PCI） is a common treatment strategy for ST-segment elevation acute myocardial infarction （STEMI）, scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study. Methods This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients （age 〈70 years） with STEMI who presented within 12 hours of symptom onset （mean interval 〉3 hours）. Patients were randomized to three groups： primary PCI group （n=101）; recombinant staphylokinase （r-Sak） group （n=-104）; and recombinant tissue-type plasminogen activator （rt-PA） group （n=-106）. For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery （IRA） patency; rescue PCI was performed in cases with TIMI flow grade 〈2. Bare-metal stent implantation was planned for all patients. Results After randomization it required an average of 113.4 minutes to start thrombolytic therapy （door-to-needle time）and 141.2 minutes to perform first balloon inflation in the IRA （door to balloon time）. Rates of IRA patency （TIMI flow grade 2 or 3） and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure （70.5% vs. 98.0%, P 〈0.0001, and 53.0% vs. 85.9%, P 〈0.0001, respectively）. Rescue PCI with stenting was performed in 117 patients （55.7%） in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group （88.9% vs. 97.9%, P=-0.0222, and 68.4% vs. 85.0%, P=0.0190, respectively）. At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group （7.1% vs. 0, P=0.0034）. Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group （10.0% vs. 1.0%, P=-0.0380, and 28.10% vs. 8.91%, P=-0.O001, respectively）. Conclusions Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Background： Previous studies of contrast-induced acute kidney injury （CI-AK1） were mostly based on selective percutaneous coronary intervention （PCI） cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKi in a Chinese population undergoing emergency PCI. Methods： A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AK1 and non-CI-AKl group. Univariable and multivariable analyses were used to identity the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl （44.2 μmol/L） above baseline within 3 days alter exposure to contrast medium. Results： The incidence of C1-AKI in patients undergoing emergency PCI was 22.7% （241/1061）. Logistic multivariable analysis showed that body surface area （BSA） （odds ratio [OR] 0.213, 95% confidence interval [CI]： 0.075-0.607, P = 0.004）, history, of myocardial infarction （MI） （OR 1.642, 95% CI. 1.079-2.499, P- 0.021 ）, left ventricular ejection fraction （LVEF） （OR 0.969, 95% CI： 0.944-0.994, P = 0.015）, hemoglobin （Hb） （OR 0.988, 95% CI. 0.976-1.000, P 1.018 1.037, P 〈 0.001 ）, left anterior descending （LAD） stented （OR 1 0.009 0.987, P- 0.049）, and diuretics use （OR 1.850, 95% CI： 1.233-2 0.045）, estimated glomerular filtration rate （OR 1.027, 95% CI： 464, 95% CI： 1.000 2.145, P 0.050）, aspirin （OR 0.097, 95%CI： .777, P - 0.003） were independent predictors of CI-AKI in patients undergoing emergency PCI. Conclusion： History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AK1 in patients undergoing emergency PCI.

Coronary thrombus in patients undergoing primary PCI for STEMI:Prognostic significance and management

Acute ST-elevation myocardial infarction(STEMI) usually results from coronary atherosclerotic plaque disruption with superimposed thrombus formation. Detection of coronary thrombi is a poor prognostic indicator,which is mostly proportional to their size and composition. Particularly,intracoronary thrombi impair both epicardial blood flow and myocardial perfusion,by occluding major coronary arteries and causing distal embolization,respectively. Thus,although primary percutaneous coronary intervention is the preferred treatement strategy in STEMI setting,the associated use of adjunctive antithrombotic drugs and/or percutaneous thrombectomy is crucial to optimize therapy of STEMI patients,by improving either angiographical and clinical outcomes. This review article will focus on the prognostic significance of intracoronary thrombi and on current antithrombotic pharmacological and interventional strategies used inthe setting of STEMI to manage thrombotic lesions.

Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention

Background： Mounts of studies have shown that low estimated glomerular filtration rate （eGFR） is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury （CI-AKI） in a Chinese population who underwent an emergency percutaneous coronary intervention （PCI）. Methods： Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint （including nonfatal myocardial infarction, revascularization, stroke, and all-cause death） at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.Results： A total of 1061 patients were included and the overall CI-AKI rate was 22.7% （241 / 1061）. The separate rates were 77.8% （7/9） in Group 1 （eGFR 〉 120 ml·min^-1 -1.73 m^-2）, 26.0% （118/454） in Group 2 （120 ml·min^-1·min^-11.73 m^-2〉 eGFR≥90 ml·min^-1 1.73^-2）, 18.3% （86/469） in Group 3 （90 ml·min^-1 1.73 m^-2〉 eGFR 〉60 ml·min^-1·min^-11.73 m^-2）, 21.8% （26/119） in Group 4 （60 ml·min^-1·1.73 m^-2〉 eGFR≥30 ml·min^-1·min^-11.73 m^-2）, and 40.0% （4/10） in Group 5 （eGFR 〈30 ml·min^-1·min^-1·min^-11.73 m^-2）, with statistical significance （χ^2 = 25.19, P 〈 0.001）. The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing （the higher the level of eGFR, the higher the CI-AKI occurrence in case ofeGFR_〉60 ml·min^-1·1.73 m^-2）. The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences （χ^2 = 16.26, P = 0.009 at 6-month follow-up, and χ^2 = 49.05, P 〈 0.001 at 12-month follow-up）. The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients. Conclusions： High level ofeGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Triple antithrombotic therapy versus double antiplatelet therapy after percutaneous coronary intervention with stent implantation in patients requiring chronic oral anticoagulation： a meta-analysis

Background Whether an addition of OAC to double antiplatelet therapy for patients with an indication of chronic oral anticoagulation undergoing PCI-S may improve clinical outcomes is still debated. This meta-analysis aimed to update and re-compare the benefits and risks of triple antithrombotic therapy （TT） with double anti-platelet therapy （DAPT） after in patients who requiring oral anticoagulation after percutaneous coronary interventions with stenting （PCI-s）. Methods Ten reports of observational retrospective or prospective studies were retrieved, including a total of 6296 patients, follow-up period ranging from 1 year to 2 years. Results Baseline characteristics were similar in both groups. The main finding of this study is the overall incidence of major adverse cardiovascular events （MACE）, myocardial infarction （MI） and stent thrombosis was comparable between two groups. Patients with TT was associated with significant reduction in ischemic stroke （OR： 0.27; 95% CI： 0.13-0.57; P=0.0006） as compared to DAPT. We reaffirmed triple therapy significantly increased the risk of major bleeding （OR： 1.47; 95% CI： 1.22-1.78; P 〈0.0001） and minor bleeding （OR： 1.55; 95% CI： 1.07-2.24; P=-0.02）. Conclusions Triple therapy is more efficacious in reducing the occurrence of ischemic stroke in PCI-s patients with an indication of chronic oral anticoagulation （OAC）, compared with DAPT. However, it significantly increased major and minor risk of bleeding. It is imperative that further prospective randomized controlled trials are required to define the best therapeutic strateav for patients with an indication of chronic OAC underaoina PCI-s.

Efficacy and safety of triple-antiplatelet therapy after percutaneous coronary intervention： a meta-analysis

Background The combination of cilostazol, aspirin and clopidogrel （triple antiplatelet therapy, TAT） after a percutaneous coronary intervention has been used as an alternative therapy. We performed a meta-analysis to evaluate the efficacy and safety of TAT for patients after percutaneous coronary intervention （PCI）. Methods We systematically searched Pubmed, Embase and Web of Science databases to identify all randomized controlled trials （RCTs） that compared dual antiplatelet therapy （DAT） with and without cilostazol after PCI. All analyses were conducted using Review Manager 5.0. Results The final analysis consisted of 4474 patients from ten studies. The combined results suggested that there was a lower risk of cardiac death （relative risk （RR）=0.55, 95% confidence interval （Cl）： 0.31-0.98, P 〈0.05） and major adverse cardiac events （MACEs） （RR=0.63, 95% Cl： 0.54-0.74, P 〈0.05） in patients treated with TAT as compared to those with DAT follow-ups after six months to one year; no significant difference was observed in bleeding and non-fatal myocardial infarction （MI） （RR=1.14, 95% Cl： 0.80-1.64, P 〉0.055 RR=0.87, 95% Cl： 0.42-1.83, P 〉0.05）. However, the rate of adverse drug reaction was higher in patients receiving TAT than in patients receiving DAT （RR=2.21, 95% Cl： 1.84-2.66, P 〈0.05）. Moreover, there was a lower risk of stent thrombosis in patients treated with TAT as compared to those treated with DAT （RR=0.44, 95% Cl： 0.21-0.94, P 〈0.05）. The TAT group had a reduced risk of target lesion revascularization （TLR） （RR=0.60, 95% Cl： 0.43-0.82, P=-0.001） and target vessel revascularization （TVR） than the DAT group （RR=0.56, 95% Cl： 0.45-0.71, P 〈0.05）. The number of MACEs was lower for patients in the TAT group than in the DAT group with diabetes mellitus sub-analysis （RR=0.41, 95% Cl： 0.28-0.61, P 〈0.05）. But no significant difference was observed between the two groups regarding MACEs in patients with drug-eluting stent implantations （RR=0.82, 95% Cl： 0.65-1.03, P 〉0.05）. Conclusion TAT could significantly reduce the rates of MACEs and cardiac death in comparison to DAT, but more attention should be paid to adverse side effects of the drugs.

Efficacy of Short-term Dual Antiplatelet Therapy after Implantation of Second-generation Drug-eluting Stents:A Meta-analysis and Systematic Review

Objective The benefit of short-term dual antiplatelet therapy(DAPT) following second-generation drug-eluting stents implantation has not been systematically evaluated. To bridge the knowledge gap,we did a meta-analysis to assess the efficacy of ≤6 months versus ≥12 months DAPT among patients with second-generation drug-eluting stents. Methods We searched online databases and identified randomized controlled trials that assess the clinical impact of short-term DAPT(≤6 months) published before March 3,2016. The efficacy endpoints included the incidence of all-cause death,myocardial infarction,cerebrovascular accidents,and definite or probable stent thrombosis. Safety endpoint defined as major bleeding was also evaluated and discussed. Results We included 5 trials that randomized 9473 participants(49.8%,short-term DAPT duration vs. 50.2%,standard duration). A total of 9445(99.7%) patients reported the efficacy endpoints,and the safety endpoint was available from 4 studies(n=8457). There was no significant difference in efficacy endpoints between short-term and standard DAPT duration(≥12 months) [risk ratio(RR) 0.96; 95% confidence intervals(CI),0.80-1.15]. Short-term DAPT duration did not significantly increase the individual risk of all-cause death,myocardial infarction,cerebrovascular accidents,or definite or probable stent thrombosis. Although short-term DAPT obviously reduced risk of major bleeding compared with standard DAPT(RR 0.53; 95% CI,0.29-0.96),significant publication bias was found when accessing the safety endpoint of the 4 studies(Egger's test,P=0.009). Conclusions The efficacy of short-term DAPT was comparable with that of standard duration DAPT.DAPT less than 6 months may be appropriate for patients receiving second-generation drug-eluting stents implantation.

Clinical follow up of patients with premature coronary artery disease (PCAD) implanted with drug-eluting stents

Background: Drug-eluting stents (DESs) are associated with lower restenosis rates. However, minimal data on the follow up results of premature coronary artery disease (PCAD) treated with DESs exist. This study was to evaluate clinical characteristics and one- year prognosis of PCAD implanted with DESs in a Chinese population. Methods: 282 patients with PCAD, of which 177 implanted with DESs and 105 prescribed medicine alone were enrolled and analyzed. Major adverse cardiovascular events (MACEs) and the use of medications for secondary prevention were collected and analyzed. Results: Compared with those receiving medicine alone, patients implanted with DESs had higher ratios of males than females, they also had acute coronary syndromes, multi-vessel disease, higher values of cardiac troponin I, longer hospital stays, higher aspirin and clopidogrel use (all P β-blockers and statins use during follow-up, they had higher ratios of recurrent angina and composite MACEs during one-year follow- up (all P y syndrome (OR 1.716, 95% CI: 1.011 - 2.913) and reduced left ventricular ejection fraction (OR 2.539, 95% CI: 1.180 - 5.463) predict MACEs in a one-year follow-up among patients with PCAD. Conclusions: PCAD patients implanted with DESs have more unstable clinical phenotypes and higher MACEs during a one-year follow-up period, though they were prescribed higher ratios of optimal therapeutic medicine. Further enhanced strategies should be made for secondary prevention.

The impact of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction(STEMI)patients after emergency percutaneous coronary intervention(PCI).Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group(standard group,n=60),and 40 mg of atorvastatin treatment group(intensive group,n=60).

Clinical characteristics of patients readmitted for stroke with double anti-platelet therapy after percutaneous coronary intervention

Background The clinical characteristics of stroke patients treated with double anti-platelet therapy （DAPT） after percutaneous coronary intervention （PCI） is not clear. Methods In total, 2675 patients under- went PCI and DAPT in Guangdong General Hospital, and 68 out of them were hospitalized due to suspected stroke, of whom 23 were diagnosed as having stroke. Data of the 23 stroke patients were collected and tradi- tional risk factors associated with stroke were analyzed retrospectively. Results The mean age of these pa- tients was 75.6± 8.7 years, and 20 （87.0%） were males. Notably, 19 patients were complicated with hyper- tension, 7 with diabetes mellitus, 7 with previous history of stroke, none with atrial fibrillation （AF） or patent foramen ovale （PFO）. Specifically, 22 patients were diagnosed with ischemic stroke, and 1 patient with hemorrhagic stroke. Conclusion Stroke in patients treated with DAPT after PCI was correlated with ad- vanced age, gender, hypertension, diabetes mellitus, stroke history. Long term electrocardiography （ECG） may be needed for the diagnosis of AF, while trans-esophageal echocardiography （TEE） may be needed for PFO.

血府逐瘀汤对STEMI病人PCI术后炎症指标、再灌注后心功能及生存质量的影响

目的:探讨血府逐瘀汤对ST段抬高型心肌梗死(STEMI)病人经皮冠状动脉介入治疗(PCI)术后炎症指标及再灌注后心功能及生存质量的影响。方法:选取2020年1月1日—2021年12月31日于我院接受PCI治疗的STEMI病人244例作为研究对象,采用计算机随机化法分为研究组和对照组,每组122例。研究组给予血府逐瘀汤+PCI术后常规基础治疗,对照组给予PCI术后常规基础治疗,两组病人均随访6个月。对比两组主要心脑血管不良事件(MACCE)发生情况、心肌梗死多维度量表(MIDAS)评分、美国纽约心脏协会(NYHA)心功能分级、不良反应发生情况、中医临床症状积分、中医证候疗效、左心室重构情况及炎性因子[白细胞介素-6(IL-6)、内皮素-1(ET-1)、一氧化氮(NO)以及基质金属蛋白酶-9(MMP-9)]水平。结果:研究组MACCE总发生率低于对照组,NYHA心功能分级改善情况优于对照组,中医证候疗效优于对照组(P<0.05)。治疗后,两组MIDAS评分均较治疗前降低,且研究组低于对照组(P<0.05)。治疗后,两组中医临床症状积分均较治疗前下降,且研究组低于对照组(P<0.05)。治疗后,两组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)降低,左室射血分数(LVEF)升高,且研究组LVESD、LVEDD低于对照组,LVEF高于对照组(P<0.05)。治疗后,两组IL-6、ET-1、MMP-9降低,NO升高,且研究组IL-6、ET-1、MMP-9低于对照组,NO高于对照组(P<0.05)。结论:血府逐瘀汤应用于STEMI病人PCI术后能显著提高病人的整体生存质量,降低MACCE发生风险,改善心功能,减轻炎症反应,有利于病人预后。

基于中医情志护理的健康宣教结合五音疗法对冠心病经皮冠状动脉介入术术后患者焦虑抑郁及睡眠质量的影响

目的观察基于中医情志护理的健康宣教结合五音疗法对冠心病经皮冠状动脉介入术(PCI)术后患者焦虑抑郁及睡眠质量的影响。方法选择2022年1月至2023年8月赣南医学院第一附属医院收治的60例行PCI的冠心病患者为研究对象,按照随机数字表法将其分为对照组(30例)、观察组(30例),对照组采用常规护理,观察组采用基于中医情志护理的健康宣教结合五音疗法护理。比较两组患者的睡眠质量、焦虑和抑郁情绪、健康行为、中医证候积分情况。结果观察组护理后的Spiegel睡眠量表评分低于对照组,差异有统计学意义(P<0.05)。观察组护理后的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均低于对照组,差异有统计学意义(P<0.05)。观察组护理后的健康行为评分高于对照组,差异有统计学意义(P<0.05)。观察组护理后的心胸疼痛、胸闷、心悸、气短、心中烦躁、夜寐不安、精神不振评分均低于对照组,差异有统计学意义(P<0.05)。结论冠心病PCI术后给予患者基于中医情志护理的健康宣教结合五音疗法,可明显改善患者睡眠质量、心理状态,缓解患者心胸疼痛、胸闷、心悸等症状,改善患者健康行为,可广泛应用。