A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

The safety and effectiveness of ticagrelor early postoperative mono-antiplatelet Therapy in patients with percutaneous coronary intervention

Objective The purpose is to investigate the safety and effectiveness of ticagrelor early postoperative mono-antiplatelet therapy in patients with percutaneous coronary intervention(PCI).Methods 832 patients who choose ticagrelor for anti-platelet therapy from August 2015 to December 2016 and underwent PCI with the second generation drug-eluting stent(DES)was selected.

Comparison of the curative effect of intracoronary retrograde thrombolysis and thrombus aspiration combined with stent implantation on STEMI patients

Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditional stent implantation in patients with acute ST-segment elevation myocardial infarction.Methods:From January 2018 to October 2019,184 patients diagnosed with acute ST-segment elevation myocardial infarction and infarction-related arterial blood flow TIMI 0 grade in the First Affiliated Hospital of Hainan Medical College and percutaneous coronary intervention(PCI)were selected.According to different surgical methods,patients were divided into intracoronary retrograde thrombolysis combined with stent implantation group(thrombolysis group,n=57 cases),thrombus aspiration combined with stent implantation group(aspiration group,n=57 cases)),traditional stent implantation group(traditional group,n=70 cases).Compare the incidence of no-reflow phenomenon after percutaneous coronary intervention,the rate of 1 hour ST_segment fall≥50%in the ECG after PCI,and the main adverse cardiovascular events(MACE)during hospitalization;compare the left ventricular end-diastolic diameter(LVEDD)、left ventricular ejection fraction(LVEF)and major adverse cardiovascular events at 1 year after PCI.Results:1.The short-term effects:The incidence of no-reflow phenomenon in the thrombolytic group was lower than that of the aspiration group and the traditional group,and the rate of 1hSTR≥50%was higher than that of the aspiration group and the traditional group,the difference was statistically significant(P<0.05).2.The long-term effects:1 year after percutaneous coronary intervention,the LVEDD of the thrombolytic group was lower than that of the aspiration group and the traditional group,while the LVEF was higher than the aspiration group and the traditional group,and the incidence of major adverse cardiovascular events in the thrombolytic group at was lowest,both the difference was statistically significant(P<0.05).Conclusion:The application of intracoronary retrograde thrombolysis combined with stent implantation in STEMI patients can reduce the occurrence of no-reflow,improve long-term cardiac function,and reduce the occurrence of major adverse cardiovascular events for short-term and long-term.

PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.

Evaluation of long stent implantation in diffuse coronary lesions for octogenarians

Objective To evaluate angiographic and clinical outcomes of ≥ 20mm long stents or overlapped stent implantation in diffuse coronary lesions for octogenarians, in comparison with patients under sixty. Methods Two groups (Group O: 47 lesions in 44 octogenarians, aged 81± 3 years; Group Y: 64 lesions in 58 patients under sixty, aged 54 ± 4 years) were compared with a 6-month follow-up. Results Success rate of the procedures was 100%. None had in-hospital major adverse cardiac events (MACE). There was no significant difference in angiographic restenosis between the groups at follow-up (Group O vs Group Y, 29.8 % vs 26.6 %, P = NS). The revascularization of target vessel and MACE was less in Group Y, but these showed no statistical significance (15.6% vs 23.4% and 20.7% vs 25.0%, respectively). Conclusions Long stent implantation for diffuse coronary lesions in octogenarians appears safe and feasible, with high procedural success and favorable long-term outcomes.

Clinical significance of provoked coronary spasm at chronic stage in patients who underwent successful complete coronary revascularization with first-generation drug-eluting stents

Background: Provoked spasm might have influence on cardiovascular events even after successful DES implantation. Methods and results: A consecutive 122 patients who underwent first-generation DES (CypherTM, and TaxusTM) implantation and had no residual stenosis at follow-up coronary angiography were included. All patients also underwent acetylcholine provocation test (ACh) at follow-up angiography. Age, sex, coronary risk factors (smoking, hypertension, diabetes mellitus, dyslipidemia), medication (calcium channel blockers, angiotensin receptor blockers, angiotensin converting enzyme inhibitors, nitrates, β blockers, statins), duration from stent implantation to follow-up angiography (15.5 ± 14.5 months), old myocardial infarction, Ach + were included as variables for multivariate analysis for cardiovascular events (angina pectoris without intervention, target lesion revascularization, acute myocardial infarction, definite or probable stent thrombosis, cardiac death, and stroke). ACh provocation test was positive in 64.8%. The following events occurred during a mean follow-up period of 26.9 ± 9.5 months;angina pectoris without intervention in 12, very late stent thrombosis in 1, acute myocardial infarction in 1, sudden death in 1, and stroke in 4. By Adjusted Cox hazard model, age was the independent predictor of future cardiovascular events. ACh was unbalanced data for Cox hazard model, and by logistic regression model, ACh was the strongest predictor. Conclusions: Coronary endothelial dysfunction at chronic stage is the strongest predictor of further prognosis in patients with first-generation DES.

双心护理结合早期康复策略在急性心肌梗死患者中的应用价值

目的研究双心护理结合早期康复策略在行经皮冠脉介入术(PCI)后的急性心肌梗死患者中的应用价值。方法以随机数字表法将2021年3月至2022年7月在东南大学附属中大医院行PCI的90例急性心肌梗死患者分为2组,各45例。对照组接受早期康复结合常规护理,观察组在对照组干预方法的基础上接受双心护理。比较2组的心功能指标、不良情绪、生活质量和心血管不良事件发生情况。结果术后1个月和3个月,2组的N末端脑钠肽前体水平均较术前降低,且观察组均比同期对照组更低;2组的左室射血分数均较术前增大,且观察组均比同期对照组更大;2组的6分钟步行试验距离均较术前增长,且观察组均比同期对照组更长,上述比较均有统计学差异(P均<0.05)。术后1个月和3个月,观察组的不良情绪评分(汉密尔顿焦虑/抑郁量表)均低于同期对照组(P均<0.05),且2组均低于术前(P均<0.05)。术后3个月,2组的生存质量精简量表各项评分均较术前高(P均<0.05),且观察组均高于对照组(P均<0.05)。观察组的心血管不良事件总发生率低于对照组(P<0.05)。结论双心护理结合早期康复策略可改善行PCI后的急性心肌梗死患者的心功能、不良情绪和生活质量,也可预防心血管不良事件的发生。

接受再灌注治疗的ST段抬高型心肌梗死患者死亡率性别差异的荟萃分析

目的 探讨接受再灌注治疗的ST段抬高型心肌梗死(STEMI)患者死亡率的性别差异。方法 全面检索PubMed、EMBASE、万方数据库、中国知网和谷歌学术等数据库自建库至2023年8月1日的文献中,对接受溶栓治疗或直接经皮冠状动脉介入术(PPCI)的STEMI患者短期或长期死亡率的性别差异进行对比的相关研究。观察性研究和随机对照研究均纳入本研究。使用Rev Man 5软件进行统计学分析。使用危险度(RR)和95%CI表示性别差异对STEMI患者死亡率的影响。使用漏斗图评估研究偏倚。结果 共纳入36项研究,其中33项观察性研究和3项随机对照研究,共108 132例STEMI患者,其中男性82 848例,女性25 284例。与男性患者相比,女性患者住院期间(RR=1.73,95%CI:1.52~1.98,P<0.001,I~2=69%)、1个月(RR=1.89,95%CI:1.74~2.06,P<0.001,I~2=46%)、1年(RR=1.56,95%CI:1.40~1.74,P<0.001,I~2=0%)和2年(RR=1.78,95%CI:1.51~2.10,P<0.001,I~2=43%)死亡率显著增加。在调整后的分析中,女性STEMI患者住院期间(RR=1.60,95%CI:1.27~2.02,P<0.001,I~2=69%)、1个月(RR=1.40,95%CI:1.04~1.88,P<0.001,I~2=65%)和2年(RR=1.25,95%CI:1.10~1.42,P<0.001,I~2=48%)死亡率仍明显高于男性患者。结论 对于接受再灌注治疗的STEMI患者,女性的短期和长期死亡率均高于男性。

早期心脏康复方案在急性心肌梗死经皮冠状动脉介入治疗患者中的作用分析

目的:探讨早期心脏康复方案对急性心肌梗死经皮冠状动脉介入治疗(PCI)患者的应用效果。方法:选取2022年1月至2023年1月期间本院收治的68例急性心肌梗死患者作为研究对象。采用随机数字表法将患者分为对照组和观察组,每组各34例。对照组采用常规术后康复护理,观察组在对照组基础上采用早期心脏康复方案。分析比较两组的运动功能[6 min步行试验(6MWT)]、生活质量及心血管不良事件。结果:护理前,两组的6MWT无显著差异(P>0.05)。护理3m后,两组6MWT均升高,且观察组的6MWT较对照组显著提高(P<0.05)。观察组的心血管不良事件发生率显著低于对照组(P<0.05)。护理前,两组的躯体功能、心理功能、社会功能、物质生活各项生活质量评分均无显著差异(P>0.05)。护理后,两组的各项生活质量评分均比护理前提高,且观察组的各项生活质量评分均显著高于对照组(P<0.05)。结论:早期心脏康复方案能够改善急性心肌梗死患者PCI术后运动功能,减少心血管不良事件发生,提高患者的生活质量。

经皮冠状动脉介入术后早期康复训练频率对急性心肌梗死患者临床指标的影响

目的:探讨经皮冠状动脉介入(PCI)术后早期康复训练频率对于急性心肌梗死(AMI)患者临床指标的影响。方法:选取2023年1月至2024年1月在郑州市第七人民医院接受PCI治疗的196例AMI患者纳入本研究,根据患者PCI术后早期康复训练频率将入选患者划分为常规组与高频组,每组各98例。训练1个月后,比较两组患者心功能指标、活动耐力指标、应激反应指标、肺功能指标。结果:训练后,高频组患者左心室射血分数(LVEF)高于常规组,左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)低于常规组,差异具有统计学意义(P<0.05)。训练后,高频组患者最大运动功率、最大运动时间、6 min步行试验(6MWT)高于常规组,差异具有统计学意义(P<0.05)。训练后,高频组患者血清髓过氧化物酶(MPO)、超敏C反应蛋白(hs-CRP)、可溶性细胞间黏附分子-1(sICAM-1)、核因子κB(NF-κB)水平低于常规组,差异具有统计学意义(P<0.05)。训练后,高频组患者第1秒用力呼气量(FEV1)、用力肺活量(FVC)、呼气流量峰值(PEF)高于常规组,差异具有统计学意义(P<0.05)。结论:PCI术后早期高频率康复训练能够更好地改善AMI患者PCI术后的心肺功能、增强患者活动耐力。

患者参与式决策结合早期心脏康复护理对急诊PCI术后患者风险感知及心脏康复的影响

目的 探究患者参与式决策结合早期心脏康复护理对急诊经皮冠状动脉介入治疗(PCI)术后患者风险感知及心脏康复的影响。方法 选择2022年2月至2023年2月我院收治的176例急性心肌梗死行急诊PCI术患者为研究对象,以随机数字表法将其分为对照组和观察组,每组88例。对照组急诊PCI术后接受常规护理,观察组在对照组基础上加施患者参与式决策结合早期心脏康复护理。比较两组的干预效果。结果干预后,观察组的社会心理风险、身体诊疗风险、经济风险评分低于对照组(P<0.05)。干预后,观察组的心输出量(CO)低于对照组,左心室射血分数(LVEF)高于对照组(P<0.05)。干预后,观察组的决策冲突量表(DCS)评分低于对照组,纽卡斯尔护理服务满意度量表(NSNS)评分高于对照组(P<0.05)。结论 患者参与式决策结合早期心脏康复护理用于急诊PCI术后护理中可降低患者风险感知及决策冲突,有助于提升护理满意度及心脏康复效果,值得推广。

早期心脏康复护理干预对急性心肌梗死PCI术后患者心功能及运动耐力的影响

目的 探讨早期心脏康复护理干预在急性心肌梗死经皮冠状动脉介入(PCI)术后患者中的应用效果。方法 60例行PCI治疗的急性心肌梗死患者随机分为两组各30例。术后,对照组采用常规康复护理干预,观察组采用早期心脏康复护理干预。比较两组的心功能指标、运动耐力以及心脏不良事件。结果 干预后,观察组的LVEF显著高于对照组,LVESD、 LVEDD均显著低于对照组,6MWT显著长于对照组(P <0.05)。观察组的心脏不良事件总发生率为6.67%,显著低于对照组的30.00%(P <0.05)。结论 早期心脏康复护理干预能够显著改善急性心肌梗死PCI术后患者的心功能,提高其运动耐量,减少其心脏不良事件的发生。

早期心脏康复策略对急性心肌梗死行经皮冠状动脉介入术术后近期和远期康复效果的影响

目的:观察早期心脏康复策略对急性心肌梗死(AMI)行经皮冠状动脉介入术(PCI)术后近期和远期康复效果的影响。方法:选取医院2019年1月—2021年1月收治的80例AMI病人为研究对象,随机分为观察组、对照组,每组40例。对照组行常规干预,观察组予以早期心脏康复策略干预,比较两组病人近期疗效(心功能、生活自理能力和运动耐力)和远期疗效(生活质量和并发症)。结果:观察组病人心功能、6 min步行试验(6MWT)、Barthel指数均优于对照组(P<0.05);观察组病人生活质量评分明显高于对照组(P<0.05),并发症发生率低于对照组(P<0.05)。结论:对AMI病人行PCI术后施予早期心脏康复策略干预,能有效促进心功能恢复,提高自理生活能力,改善远期生活质量,减少并发症。

早期下床活动对经桡动脉行冠状动脉介入术患者应用效果的Meta分析

目的系统评价经桡动脉行冠状动脉介入术患者术后早期下床活动的效果。方法检索1993年1月1日至2023年12月31日发表在Cochrane Library、PubMed、Web of Science、Embase、中国知网、中国生物医学文献数据库、维普资讯网、万方数据库和国内外临床试验注册中心有关经桡动脉行冠状动脉介入术后早期下床活动的试验性研究,对纳入研究进行质量评价,采用RevMan 5.3软件进行Meta分析。结果最终纳入12项研究,Meta分析结果显示,与常规康复相比,经桡动脉行冠状动脉介入术后早期下床活动有利于改善患者左室射血分数[MD=4.35,95%CI(1.96,6.74),P<0.01];能提高患者生活质量[SMD=2.56,95%CI(1.37,3.75),P<0.01];增强患者日常生活能力[MD=3.78,95%CI(1.87,5.69),P<0.01];降低心绞痛[OR=0.35,95%CI(0.16,0.79),P=0.01]、心律失常[OR=0.33,95%CI(0.15,0.70),P<0.01]和心力衰竭[OR=0.35,95%CI(0.13,0.91),P=0.03]发生率;对改善冠状动脉再狭窄[OR=0.28,95%CI(0.07,1.16),P=0.08],左室舒张末内径[MD=-1.53,95%CI(-4.58,1.53),P=0.33]和6分钟步行距离[MD=32.87,95%CI(-2.03,67.77),P=0.06]效果不显著。结论早期下床活动可以明显改善经桡动脉行冠状动脉介入术后患者的心功能,提高其生活质量和日常生活能力,减少并发症,促进患者的康复。

四阶段式早期康复训练对急性心肌梗死经桡动脉穿刺冠状动脉介入术后患者的应用效果

目的探讨四阶段式早期康复训练应用于急性心肌梗死经桡动脉穿刺冠状动脉介入术(percutaneous coronary intervention,PCI)后患者的效果。方法选择2020年5月-2022年5月于笔者所在医院行PCI术的80例急性心肌梗死患者为研究对象。采用随机数字表法将其分为对照组和观察组,各40例。对照组给予PCI术后常规护理及康复训练。观察组在术后常规护理的基础上实施四阶段式早期康复训练。比较2组首次下床时间、住院时间、心功能指标、生活质量及并发症情况。结果干预后,观察组首次下床时间早于对照组(t=98.992,P<0.001),住院时间短于对照组(t=6.545,P<0.001);观察组左室射血分数和6 min步行步距离均高于对照组(t=3.508,P<0.001;t=8.956,P<0.001),左心室舒张末期内径低于对照组(t=6.439,P<0.001);生活质量各维度得分均高于对照组(均P<0.05);并发症发生率低于对照组(χ2=4.012,P=0.045)。结论对急性心肌梗死经桡动脉PCI术后患者应用四阶段式早期康复训练,能够有效改善患者心功能,提高其生活质量,降低并发症发生率,有利于患者术后康复。

rhTNK-tPA溶栓治疗对STEMI患者PCI术后并发症及心血管血流状态的影响研究

目的 探讨注射用重组人TNK组织型纤溶酶原激活剂(recombinant human TNK tissue type plasminogen activator, rhTNK-tPA)溶栓治疗对ST段抬高型心肌梗死(ST segment elevation myocardial infarction, STEMI)患者经皮冠状动脉介入术(percutaneous coronary intervention, PCI)后的影响。方法 方便选取2021年1月—2024年2月安溪县医院收治的84例STEMI患者为研究对象,根据是否溶栓治疗分组,对照组40例未接受溶栓治疗,直接行PCI;观察组44例经rhTNK-tPA溶栓治疗后行PCI,比较两组术后并发症发生情况、心血管血流状态及凝血功能。结果 两组术后并发症发生率比较,差异无统计学意义(P>0.05)。术前,两组心肌梗死溶栓试验血流分级比较,差异无统计学意义(P>0.05);术后,观察组2级2.27%(1/44)、3级97.73%(43/44),均优于对照组的2级27.50%(11/40)、3级72.50%(29/40),差异有统计学意义(Z=10.889,P<0.05)。术前,两组凝血功能比较,差异无统计学意义(P>0.05);术后,观察组凝血酶原时间、凝血酶时间、部分活化凝血酶时间均长于对照组,纤维蛋白原低于对照组,差异有统计学意义(P均<0.05)。结论 rhTNK-tPA溶栓治疗不会增加STEMI患者PCI术后并发症,且能改善心血管血流状态与凝血功能。

院前静脉溶栓对STEMI患者微循环血流灌注及短期预后的疗效观察

目的 院前静脉溶栓对ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)术中微循环血流灌注及短期预后的疗效。方法 收集2022年6月至2023年6月收治的STEMI患者,根据再灌注策略,将患者分为院前静脉溶栓后PCI组(58例,A组)和急诊转运PCI组(58例,B组)。比较2组介入术中情况、重要部位出血情况及主要不良心脑血管事件(MACCE)。结果 A组较B组再灌注时间明显缩短,术前TIMI血流分级≥2级比例增多,置入支架数量下降,术后无复流/慢血流发生率减少;术后7、30、90d复查心脏超声,A组左心室舒张末内径及WMSI下降,A组30、90 d LVEF升高(P<0.05);2组患者主要出血事件及MACCE发生率差异无统计学意义(P>0.05)。结论 患者给予院前静脉溶栓能够缩短心肌缺血再灌注时间,减少术中微循环灌注障碍发生率,但主要出血事件和MACCE未增加。

回阳复脉汤辅助PCI术对心肾阳虚型急性心肌梗死患者TIMI血流分级、冠脉微循环及MACE的影响

目的探讨回阳复脉汤辅助经皮冠状动脉介入治疗(PCI)术对心肾阳虚型急性心肌梗死(AMI)患者心肌梗死溶栓试验(TIMI)血流分级、冠脉微循环及主要心血管不良事件(MACE)的影响。方法选取2021年3月至2023年3月驻马店市中医院收治的86例AMI患者进行前瞻性随机平行对照研究,按随机数表法分为PCI组和联合组各43例。PCI组患者予以PCI术,联合组患者予以回阳复脉汤辅助PCI术。比较两组患者PCI术后TIMI血流分级、冠脉血流储备(CFR)、微循环阻力指数(IMR)、TIMI心肌灌注帧数(TMPFC)、内皮素-1(ET-1)、一氧化氮(NO)、P选择素、中性粒细胞与淋巴细胞比值(NLR)、高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、纤溶酶原激活物抑制物(PAI-1)、血小板α颗粒膜糖蛋白(CD62P)、安全性及MACE发生率。结果联合组患者的TIMI血流分级Ⅰ级0例,Ⅱ级0例,Ⅲ级43例,优于PCI组的Ⅰ级1例,Ⅱ级6例,Ⅲ级36例,差异有统计学意义(P<0.05);联合组患者PCI术后即刻CFR为2.94±0.28,明显高于PCI组的2.60±0.31,IMR、TMPFC分别为12.15±2.84、(92.00±3.24)帧,明显低于PCI组的14.77±3.56、(95.18±4.67)帧,差异均有统计学意义(P<0.05);联合组患者PCI术后即刻和术后5 d的ET-1分别为(132.41±19.67)ng/L、(113.02±14.76)ng/L,明显低于PCI组的(151.33±38.95)ng/L、(148.51±40.00)ng/L,NO分别为(62.43±13.55)μmol/L、(67.89±11.22)μmol/L,明显高于PCI组的(50.68±16.24)μmol/L、(52.03±15.49)μmol/L,差异均有统计学意义(P<0.05);联合组患者PCI术后即刻和术后5 d的P选择素、NLR、hs-CRP、IL-6水平均明显低于PCI组,差异均有统计学意义(P<0.05);联合组患者PCI术后即刻和术后5 d的PAI-1、CD62P分别为(9.33±1.20)μg/L、(8.08±1.33)μg/L;(45.37±5.38)%、(40.05±4.27)%,明显低于PCI组的(12.00±1.87)μg/L、(11.17±1.65)μg/L;(48.40±6.29)%、(45.59±5.31)%,差异均有统计学意义(P<0.05);联合组患者的MACE总发生率为2.38%,明显低于PCI组的18.60%,差异有统计学意义(P<0.05)。结论回阳复脉汤辅助PCI术能改善心肾阳虚型AMI患者的TIMI血流分级、冠脉微循环、血管内皮功能及炎症反应,优化纤溶凝血系统,减少MACE的发生,增加患者临床获益。

Long-Term Follow-Up of Chinese Herbal Medicines Combined with Conventional Treatment in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: A Multicenter Randomized Controlled Trial

Objective： To evaluate the prognosis effect of Chinese herbal medicines（CHMs） for benefiting qi and activating blood circulation adjunctive to conventional treatment in patients with acute coronary syndrome（ACS） after percutaneous coronary intervention（PCI）. Methods： A total of 702 patients with ACS who underwent PCI were enrolled and randomly assigned to receive conventional treatment plus CHMs for benefiting qi and activating blood circulation（treatment group, 351 cases） or conventional treatment alone（control group, 351 cases） for 6 months. Six months later, all patients received conventional treatment alone. Follow-ups were scheduled at 6th, 12 th, 18 th, 24 th month after enrollment in April 2008, and the final follow-up visit was during September 2011 and November 2011. The primary endpoint was the composite of cardiac death, nonfatal myocardial infarction or revascularization（PCI or coronary artery bypass grafting）; and the secondary endpoint was the composite of re-admission for ACS, congestive heart failure, nonfatal stroke or other thrombus events. Results： A total of 621（88.59%） patients completed 35.4±3.8 months follow-up, while 80（11.41%） patients withdrew from the trial（41 in the treatment group and 39 in the control group）. The incidence of primary endpoint was 5.7%（20 patients） in the treatment group versus 10.86%（38 patients） in the control group [relative risk（RR）： 0.53; 95% confidence interval（CI）： 0.30, 0.88; P=0.013; absolute risk reduction（ARR）： –0.052, 95% CI： –0.06, 0.01]. The incidence of secondary endpoint was 5.98%（21 patients） in the treatment group versus 10.28%（36 patients） in control group（RR： 0.58, 95% CI： 0.33, 0.97, P=0.037; ARR： –0.043, 95% CI： 0.06, 0.01）. Most of the primary and secondary endpoints were occurred in 18 months（84.50% in the treatment group versus 78.10% in the control group）. Conclusion： CHMs for benefiting qi and activating blood circulation adjunctive to conventional treatment improved clinical outcomes for patients with ACS after PCI in long-term follow-up.

重组人尿激酶原对急性下壁ST段抬高心肌梗死患者急诊经皮冠脉介入术中无复流或慢血流的影响

目的探讨重组人尿激酶原对急性下壁ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者急诊经皮冠脉介入术(percutaneous coronary intervention,PCI)中无复流或慢血流的影响。方法选取2022年1月至2023年12月于新沂市人民医院接受治疗的80例急性下壁STEMI患者。将患者分为两组,每组40例。其中,对照组患者经导管推注100μg硝酸甘油或硝普钠后实施PCI;观察组患者在对照组基础上经导管推注20mg重组人尿激酶原至梗死相关动脉后实施PCI。采用心肌梗死溶栓(thrombolysis in myocardial infarction,TIMI)血流分级法比较两组患者的术后即刻心肌灌注情况。结果两组患者术中即刻TIMI血流分级比较,0~1级:观察组1例(2.5%),对照组7例(17.5%),两组比较差异有统计学意义(P<0.05);2级:观察组3例(7.5%),对照组8例(20.0%),两组比较差异无统计学意义(P>0.05);3级:观察组36例(90.0%),对照组25例(62.5%),两组比较差异有统计学意义(P<0.05)。结论重组人尿激酶原可有效改善急性下壁STEMI患者急诊PCI中梗死相关动脉的冠脉血流情况,改善心肌供血不足,且不增加出血等不良反应,对改善患者预后具有重要意义。