Staged versus ＂one-time＂ multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome

评估一次性对上演的 multivessel stenting 的临床的结果在老( 60 年)有 non-ST-elevation 的病人急性冠的症候群(NSTE交流)和 multivessel 疾病( MVD ) .MethodsWe 与 multivessel 分析了连续NSTE交流病人的数据经皮的冠的干预(一种总线标准)在沈阳军人的医院将军被注册在 2008 和 2012 之间的区域。60 的 1090 个合格病人的一个总数进一步被分成一次性的组(n = 623 ) 并且上演一种总线标准组(n = 467 ) 根据干预策略。主要端点是心肌的梗塞(MI ) 的合成结果或心脏的死亡在 3 年的 follow-up.ResultsThe 期间估计了心脏的死亡的 3 年的合成的率或 MI 在上演一种总线标准组是 7.0% 并且 9.5% 在一次性的组(P = 0.110 ) 。Multivariate 分析在主要事件上证实了上演一种总线标准的利益在老(HR：0.638， 95% CI：0.408-0.998， P = 0.049 ) 。在倾向， 20 匹配队，上演一种总线标准与主要事件的更低的率被联系(6.1% 对 10.4% ， P = 0.046 ) 并且 MI (3.4% 对 7.4% ， P = 0.037 ) 在三年。另外，在在 30 天的 stent 血栓有减少的趋势(0.3% 对 1.4% ， P = 0.177 ) 并且在三年(1.1% 对 2.4% ， P = 0.199 ) 在上演一种总线标准组。在 3 年的目标容器 revascularization 没有重要差别(15.5% 对 14.4% ， P = 0.746 ).ConclusionsIn 有 MVD 的老 NSTE 交流病人，上演一种总线标准可能是与一次性的一种总线标准策略相比与减少的长期的心脏的死亡或 MI 联系的最佳的策略，它需要进一步的证实。

Comparative assessment of clinical profile and outcomes after primary percutaneous coronary intervention in young patients with single vs multivessel disease

BACKGROUND Even though percutaneous coronary intervention(PCI)improved the survival of patients with acute myocardial infarction,still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease(SVD).AIM To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease(MVD).METHODS The retrospective cohort of patients were divided into two groups:SVD and MVD group.The study population consisted of both male and female young(≤45 years)patients presented with ST-elevation myocardial infarction(STEMI)at the National Institute of Cardiovascular Disease,Karachi,Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018.Pre and postprocedure management of the patients was as per the guidelines and institutional protocols.RESULTS A total of 571 patients with STEMI,≤45 years were stratified into two groups by the number of vessels involved,342(59.9%)with SVD and 229(40.1%)with MVD.The average age of these patients was 39.04±4.86 years.A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group(25.1%vs 38%,P<0.01;11.7%vs 27.5%,P<0.001)respectively.While,smoking was more prevalent among the SVD group as compare to MVD group(36.3%vs 28.4%,P=0.05).The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group(48.8%vs 39.2%,P=0.021).Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98%vs 96.5%of the patients is SVD vs MVD group.CONCLUSION The MVD comprised of around 40%of the young patients presented with STEMI.Also,this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases,therefore,preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI.

Spontaneous multivessel coronary artery spasm diagnosed with intravascular ultrasound imaging:A case report

BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.

Culprit vessel only versus ＂one-week＂ staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

ObjectiveTo 探索 &#x0201c 的影响； one-week&#x0201d；上演 multivessel 经皮的冠的干预(一种总线标准)对死亡和主要不利心脏的事件(向)上的犯人唯一的一种总线标准 .MethodsWe&#x000a0 ；回顾地与 multivessel 疾病分析了 447 个病人经历了圣片断举起在在经历在2008年7月26日和9月25日之间的一种总线标准前的 12 h 以内的心肌的梗塞( STEMI )， 2011 。在在梗塞动脉的一种总线标准的结束以后，仍然医院里的 201 个病人同意为 &#x0201c 与超过 70% 狭窄在非梗塞动脉经历一种总线标准； one-week&#x0201d；上演 multivessel 一种总线标准。246 病人 only&#x000a0 的一个总数；为犯人容器的收到的干预。后续在 2014 年 9 月 9 日结束了。这研究从任何原因在死亡检验了差别(即，心脏并且 noncardiac ) 并且在到一条犯人唯一的一种总线标准治疗途径的二治疗 groups.ResultsCompared 之间的向， &#x0201c； one-week&#x0201d；上演 multivessel 一种总线标准强烈与更大的好处被联系为 55 月所有原因死亡[41 (16.7%) vs.13 (6.5%) ， P = 0.004 ] 并且向[82 (33.3%) 对 40 (19.9%) ， P = 0.002 ] 率。另外，在心肌的梗塞的数字有重要差别[43 (17.5%) 对 20 (10.0%) ， P = 0.023 ] ，冠动脉绕过 grafting [CABG；20 (8.1%) 对 6 (3.0%) ， P = 0.021 ] ，并且一种总线标准[31 (12.6%) 对 12 (6.0%) ， P = 0.018 ] 。与 &#x0201c 相比经历犯人唯一的一种总线标准的病人； one-week&#x0201d；一种总线标准有 stent 血栓事件的一样的数字[7 (2.8%) 对 3 (1.5%) ， P = 0.522 ].ConclusionsCompared 到一条犯人唯一的一种总线标准治疗途径， &#x0201c； one-week&#x0201d；上演多容器一种总线标准为 STEMI 和多容器一种总线标准是一只保险箱和有效选择。

Optimal timing of staged percutaneous coronary intervention in ST-segment elevation myocardial infarction patients with multivessel disease

BackgroundStudies 证明了为非犯人损害的上演经皮的冠的干预(一种总线标准) 为圣片断举起的预后是有益的有 multivessel 的心肌的梗塞(STEMI ) 病人疾病。然而，上演 revascularization 的最佳的预定仍然是争论的。这研究试图 428 STEMI 发现上演 revascularization.MethodsA 的最佳的预定全部经历了主要一种总线标准并且上演了一种总线标准的有 multivessel 疾病的病人被包括。根据在主要、上演的一种总线标准之间的时间间隔，病人们被划分成三个组(在主要一种总线标准以后的 1 个星期， 1-2 星期，和 2-12 星期) 。主要端点是主要不利心血管的事件(向) ，一所有原因死亡，非致命的重新梗塞，重复 revascularization，和击合成。考克斯回归模型被用来估计在预定的上演一种总线标准和 MACE.ResultsDuring 的风险之间的协会后续， 119 个参加者有权标。在在三个组之中的向发生有统计差别(1 个星期：23.0% ；1-2 星期：33.0% ；2-12 星期：40.0% ；P = 0.001 ) 。在 multivariable 调整模型，上演一种总线标准 1 星期和 1-2 星期的预定间隔是显著地与向的更低的风险联系的两个[危险比率(HR ) ：0.40， 95% 信心间隔(CI ) ：0.24-0.65；HR：0.54， 95% CI：0.31-0.93，分别地] ，主要归因于重复 revascularization 的更低的风险(HR：0.41， 95% CI：0.24-0.70；HR：0.36， 95% CI：0.18-0.7 ) ，与主要 PCI.ConclusionsThe 以后的 2-12 星期的策略相比，为非犯人容器的上演一种总线标准的最佳的预定应该在在为 STEMI 病人的主要一种总线标准以后的二个星期以内。

Comparison of clinical outcomes between culprit vessel only and multivessel percutaneous coronary intervention for ST-segment elevation myocardial infarction patients with multivessel coronary diseases

为圣片断举起的完全的 revascularization 的 BackgroundThe 临床的意义心肌的梗塞(STEMI )病人没有心脏性的吃惊，仍然在承认期间是从有 multivessel 疾病的朝鲜心肌的梗塞登记的 1406 个 STEMI 病人全部的 debatable.MethodsA 经历了主要经皮的冠的干预( PPCI )的人，被分析。我们使用了匹配的倾向分数(PSM ) 控制在犯人之间的基线特征的差别仅仅干预(CP ) 和 multivessel 经皮的冠的干预(MP ) ，并且在两倍容器疾病(DVD ) 和三倍的容器疾病(TVD ) 之间。在 discharge.ResultsTVD 病人显示出向的更高的发生以后，主要不利心脏的事件(向)被分析一年(14.2%对8.6%， P = 0.01 )， revascularization 的任何原因(10.6%对5.9%， P = 0.01 )，并且重复一种总线标准(9.5%对5.7%， P = 0.02 )，作为与 DVD 病人相比在一年在以后期间排出。 MP 有效地减少了向(7.3%对13.8%， P = 0.03 )与为死亡的一年，而是所有原因的 CP 相比(1.6%对3.2%， P = 0.38 )， MI (0.4%对0.8%， P = 1.00 )，并且 revascularization 的任何原因(5.3%对9.7%， P = 0.09 )在有 TVD 的病人更高显示出的二治疗 groups.ConclusionsSTEMI 是可比较的向的率，同样与 DVD 相比。MP 表现在 PPCI 期间或在为没有心脏性的吃惊的 STEMI 病人的承认期间特定在这个大放大数据库的向的显示出的更低的率。因此，没有心脏性的吃惊， MP 能为 STEMI 病人被看作一种有效治疗选择。

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

BackgroundMany 研究显示了那医药治疗和经皮的冠的干预与稳定的冠的动脉疾病以病人的长期的预后有类似的效果。这研究与高风险的 angina.MethodsIn 在老病人调查了最佳的医药治疗(OMT ) 和 revascularization-plus-OMT 的效果这未来的非使随机化的研究，有 angiographically 证实的 multivessel 疾病的 241 个连续高风险的老男病人(65-92 岁) 从 2004 年 1 月在登记被注册到 2005 年4月。这些， 98 个病人经历了 OMT ， 143 加后续的 OMT.ResultsAfter 6.5 年经历了 revascularization 治疗，我们发现长期的心脏的死亡的率在比在经历了 revascularization 的那些经历了 OMT 的病人是显著地更高的(6.5年的 unadjusted 死亡率，14.3%为 OMT 对7.0%为 revascularization 病人；木头等级 P = 0.04 ) 。然而，主要不利心脏的脑血管的事件(MACCE ) 的全面风险在所有病人之中是类似的(6.5 年的 unadjusted 死亡率， 29.6% 为 OMT 对 27.3% 为 revascularization 病人；木头等级 P = 0.67 ).ConclusionsOMT 与心脏的死亡的增加被联系但是 MACCE 的类似的 6.5 年的风险与在有冠的 multivessel 的高风险的老男病人的 revascularization 相比疾病。

Is the advantage of coronary bypass graft surgery over percutaneous coronary intervention in diabetic patients with severe multivessel disease influenced by the status of insulin requirement？

几研究证明了冠的动脉绕过接枝外科(CABG ) 在有糖尿病和多容器疾病的病人比经皮的冠的干预(一种总线标准) 优异。在一种总线标准上的 CABG 的这个优点是否被限制到要求胰岛素的糖尿病患者，是未知的。我们考察包括 8 个队和 4,786 个病人在糖尿病患者把 CABG 与一种总线标准作比较的出版文学。为所有原因死亡有更低的率(相对风险(RR ) ：0.78， 95% 信心间隔(CI ) ：0.62-0.99 ) ，并且为主要不利心脏、脑血管的事件(MACCE， RR：0.59， 95% CI：0.47-0.75 ) 为与一种总线标准相比的 CABG。死亡的合成结果，心肌的梗塞并且司烧在 CABG 和一种总线标准之间是类似的(RR：0.87， 95% CI：0.54-1.42 ) 。森林阴谋的视觉检查证明在大多数分析， RR 的点估计在要求组和非胰岛素要求组的胰岛素之间是类似的。在元回归上，在胰岛素要求和 revascularization 策略的地位之间没有相互作用(P &#x0003e；0.05 为所有) 。FREEDOM 试用的仍然未出版的分析上的介绍数据显示出类似的结果。因此在当前的时代， CABG 比有更低的死亡和 MACCE 率的一种总线标准优异，但是胰岛素要求的状态没从二 revascularization 策略在结果上有效果。

COMPARISON BETWEEN CORONARY ARTERY BYPASS SURGERY AND DRUG-ELUTING STENTS IMPLANTATION TO DIABETIC PATIENTS WITH MULTIVESSEL CORONARY ARTERY DISEASE

Objective To evaluate the safety and efficacy of drug-eluting stents (DES) implantation in diabetic patients with multivessel coronary artery disease (MVD) compared with coronary artery bypass graft (CABG) on the clinical outcomes. Methods From May 2003 to April 2005, 150 consecutive type 2 diabetic patients with MVD underwent revascularization, 84 by percutaneous coronary intervention (PCI) with DES and 66 by CABG. The study end point was the incidence of major adverse cardiovascular events (MACEs) during hospital interval after procedure and follow-up. Results Most preoperative characteristics were similar in two groups, but left main disease (30% vs 4%, P=0.001) and three-vessel disease (70% vs 54%, P=0.045) were more prevalent in CABG group. Complete revascularization was achieved in more patients in CABG group than that in PCI group (82% vs 67%, P=0.037). Cumulative incidence of MACEs in hospital was similar between two groups (2.4% PCI vs 9.1% CABG, P=0.069) despite the higher early morbidity (6.1% vs 0%, P=0.022) associated with CABG. Patients were followed up clinically for a mean of 18±8 months (range 13-36 months). The incidence of MACEs remained higher after PCI with multiple DES (21.4% vs 9.1%, P=0.041) mainly driven by a more require for repeat revascularization (13.1% vs 3.0%, P=0.030). Conclusion PCI with DES implantation, combined with tight glycemic control, aggressive cardiovascular risk factor modification and antiplatelet treatment, may be a safe and feasible alternative to CABG for selected diabetic patients with multivessel disease.

Prognostic factors of non-infarct-related arterial revascularization in STEMI patients with multivessel disease

Background Multivessel disease(MVD)is common in patients presenting with ST-segment elevation myocardial infarction(STEMI).But there is controversy over how to manage significant lesions in non-infarct-related artery(non-IRA).Methods A total of 221 patients diagnosed with STEMI and MVD who underwent percutaneous coronary intervention(PCI)at our cardiology department between January 2018 and June 2021 were included in this study.Among them,115 patients underwent complete revascularization within 30 days and were assigned to the complete revascularization group,while 106 patients who did not undergo complete revascularization within 30 days were assigned to the IRA-only revascularization group.Patients were followed up at 12 months.The primary endpoint event was adverse cardiovascular events(MACEs).Results There was no significant statistical difference in MACEs between the two groups of patients,but the incidence of heart failure in the IRA-Only group was significantly higher than that in the complete revascularization group.In the complete revascularization group,the number of stents,Killip class Ⅱ/Ⅲ on admission,and complete revascularization time were independent predictors of MACEs.Receiver operating characteristic curve(ROC)curve analysis showed that complete revascularization time had good predictive power for MACEs(Area under the curve:0.74695%CI:0.680-0.801),with a cut-off value of 10.3 days.Conclusions For STEMI patients with concurrent MVD,complete revascularization can reduce the incidence of heart failure.What's more,short-term staged(within 10 days)complete revascularization may further improve clinical outcomes.

ST段抬高型心肌梗死非罪犯病变血运重建的指导策略:现状与研究进展

ST段抬高型心肌梗死(STEMI)合并多支血管病变(MVD)是冠心病的高危类型。早期开通梗死相关动脉,恢复心肌组织的血液灌注,可显著降低急性期死亡率。然而,非梗死相关动脉上存在的非罪犯病变仍存在风险,对患者远期预后具有很重要的影响。采用何种手段精准评估此类病变的临床意义和预后价值,并优化非罪犯病变的血运重建策略目前尚有争议。本文拟对STEMI合并MVD患者的非罪犯病变血运重建指导策略的研究现状及进展进行综述。

Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting （CABG） and percutaneous coronary intervention （PCI） and is an alternative to revascularization treatment. We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events （MACCE） in patients with multivessel disease undergoing hybrid coronary revascularization. Methods The data of 120 patients were retrospectively collected and the SYNTAX score, EuroSCORE, SinoSCORE and the Global Risk Classification （GRC） calculated for each patient. The outcomes of interest were 2.7-year incidences of MACCE, including death, myocardial infarction, stroke, and any-vessel revascularization. Results During a mean of 2.7-year follow-up, actuarial survival was 99.17%, and no myocardial infarctions occurred. The discriminatory power （area under curve （AUC）） of the SYNTAX score, EuroSCORE, SinoSCORE and GRC for 2.7-year MACCE was 0.60 （95% confidence interval 0.42-0.77）, 0.65 （0.47-0.82）, 0.57 （0.39-0.75） and 0.65 （0.46-0.83）, respectively. The calibration characteristics of the SYNTAX score, EuroSCORE, SinoSCORE and GRC were 3.92 （P=0.86）, 5.39 （P=0.37）, 13.81 （P=0.32） and 0.02 （P=0.89）, respectively. Conclusions In patients with multivessel disease undergoing a hybrid procedure, the SYNTAX score, EuroSCORE, SinoSCORE and GRC were inaccurate in predicting MACCE. Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

Recurrent Multivessel Coronary Artery Spasm Presented as Myocardial Infarction

Coronary artery spasm is typically a transient and marked narrowing of a single coronary artery lumen that induces myocardial ischemia.In general,patients with coronary spastic angina have a good prognosis.Herein,we described a case of recurrent diffuse multivessel coronary artery spasm presented as myocardial infarction,which was a very rare form of coronary heart disease.Although several similar ones have been reported worldwide,this is the first case rechecked by coronary angiography （CAG） in the follow-up period.

Contrast-induced nephropathy after staged percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with poor outcomes. Multivessel coronary artery disease（MVCAD） is considered to be a potentially important risk factor for CIN. There are still no data on CIN in patients undergoing staged PCI for STEMI and MVCAD. Therefore, we explored the incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population. Methods From 2011 to 2018, we enrolled 103 consecutive patients with STEMI who underwent staged PCI for MVCAD. CIN was defined as a relative increase of 〉 25% or an absolute increase of ≥ 0.5 mg/dL in SCr from the baseline value 72 h after exposure to the contrast medium. The incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population were studied. Results We found1） the incidence of CIN after primary PCI and staged PCI was 16.50% and 25.20%, respectively. 2） patients with CIN had worse in-hospital and follow-up outcomes. 3） in multivariate logistic analysis, independent risk factors for CIN included：（1） lower creatinine clearance at baseline;（2） atrioventricular block requiring temporary cardiac pacemaker implantation;（3） use of IABP at baseline;（4） total contrast volume administered（ primary PCI ＋staged PCI）;（5） shorter time interval between primary PCI and staged PCI. Conclusions CIN is a frequent complication in patients with STEMI and MVCAD undergoing staged PCI. The development of CIN is associated with worse in-hospital and follow-up outcomes.

不同低密度脂蛋白胆固醇水平合并多支血管病变的急性ST段抬高型心肌梗死患者病变特点及预后分析

目的分析不同低密度脂蛋白胆固醇(LDL-C)水平的急性ST段抬高型心肌梗死(STEMI)合并多支血管病变(MVD)患者的病变特点及预后。方法回顾性连续入选2005年1月至2015年1月就诊于首都医科大学附属北京安贞医院急诊科诊断为STEMI并成功完成直接经皮冠状动脉介入治疗的合并MVD患者1033例。选取其中入院后24 h内采集空腹LDL-C并完成12个月随访的患者1013例,根据LDL-C水平分成高LDL-C组(≥3.0 mmol/L),中等LDL-C组(1.8~<3.0 mmol/L),低LDL-C组(<1.8 mmol/L)。比较3组患者基线资料、冠状动脉病变和介入治疗情况及预后情况。采用Cox回归方法分析不同LDL-C水平与患者主要不良心脑血管事件(MACCE)和全因死亡的关系。结果本研究中高LDL-C组488例,占48.2%,中等LDL-C组461例,占45.5%,低LDL-C组64例,占6.3%。低LDL-C组罪犯血管为左前降支的比例明显高于其余2组,而高LDL-C组罪犯血管为右冠状动脉的比例较高(均P<0.05)。多元Cox回归分析结果显示,以中等LDL-C组作为参考,低LDL-C组MACCE发生风险(风险比=2.123,95%置信区间:1.007~4.472,P=0.048)及全因死亡风险(风险比=5.307,95%置信区间:1.215~23.181,P=0.026)均较高,而高LDL-C组未显示类似差异(均P>0.05)。结论STEMI合并MVD患者中LDL-C≥3.0 mmol/L占比较高,相较于中等LDL-C组,并不增加长期心血管不良事件。而LDL-C<1.8 mmol/L患者预后较差,相较于LDL-C较高的人群,这类患者从常规降脂等规范化治疗中获益较小,除了严格地降脂之外,应该更严格地控制包括残余心血管风险在内的各种危险因素。

急性冠状动脉综合征患者血浆致动脉粥样硬化指数与冠状动脉多支病变及钙化相关性研究

目的研究急性冠状动脉综合征(acute coronary syndrome,ACS)患者血浆致动脉粥样硬化指数(atherogenic index of plasma,AIP)与冠状动脉多支病变及钙化程度关系,探索其临床意义。方法纳入2021年4月至11月哈尔滨医科大学附属第一医院心内科收治的148例急性冠状动脉综合征住院患者,根据冠状动脉造影结果分为单支病变组与多支病变组,血管内超声检测结果分为轻度钙化组和重度钙化组。收集患者一般资料、AIP等生化指标及冠状动脉造影和血管内超声检测结果。结果冠状动脉多支病变组AIP显著高于单支病变组(P<0.05),重度钙化组AIP显著高于轻度钙化组(P<0.05)。进一步Spearman相关分析显示,AIP与冠状动脉多支病变及钙化程度均呈线性正相关(分别为r=0.431,P<0.01;r=0.561,P<0.01)。多因素logistic回归分析显示,AIP是ACS患者发生冠状动脉多支病变和钙化的独立危险因素(P均<0.01)。ROC曲线预测冠状动脉多支病变面积为0.750,最佳截断值0.13,灵敏度0.600,特异度0.809;预测钙化程度ROC曲线下面积为0.798,最佳截断值0.11,灵敏度0.688,特异度0.817。结论ACS患者AIP与冠状动脉多支病变及钙化程度正相关。而且,AIP可作为冠状动脉多支病变和钙化严重程度潜在预测因素。

冠心病多支血管病变患者不完全血运重建预后不良预测模型的建立

目的构建冠心病(CHD)多支血管病变(MVD)患者不完全血运重建(ICR)术后预后不良的预测模型。方法回顾性收集2020年1月至2021年5月在承德医学院附属医院行冠状动脉造影示MVD且经皮冠状动脉介入治疗(PCI)术后ICR患者的临床资料,按照出院时间顺序,将符合入选条件的受试者757例分为训练集530例(70.0%)与验证集227例(30.0%),纳入单因素Logistic回归分析中P<0.2的变量进行多因素Logistic回归分析,按照赤池信息准则(AIC)选取最优Logistic回归模型构建MVD患者ICR术后预后不良的预测模型。采用受试者工作特征(ROC)曲线下面积(AUC)验证及评估该模型的区分能力,并绘制校准曲线和决策曲线分析(DCA)曲线对该模型的校准度、临床净获益及实用性进行评估。结果用于预测MVD患者ICR术后预后不良预测模型的预测因子包括:尿酸、女性、年龄、PCI术前罪犯血管心肌梗死溶栓治疗试验血流分级、糖耐量异常、非结合胆红素。训练集与验证集的ROC的AUC分别为0.645、0.690。训练集与验证集校准曲线的Hosmer-Lemeshow检验的统计值分别为8.97(P=0.535)、16.45(P=0.087)。DCA曲线显示当主要不良心血管事件的风险阈值在0.10~0.70时本模型临床适用。结论本研究构建了用于预测MVD患者ICR术后预后不良的预测模型,该预测模型的预测能力、校准能力和临床净获益良好,能够作为临床早期预测MVD患者ICR术后预后不良的有效工具。

早发急性心肌梗死患者行经皮冠状动脉介入术后预后的影响因素分析

目的:分析早发急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后预后的影响因素。方法:回顾性分析2016年6月至2021年5月该院心血管内科收治的95例早发AMI患者的临床资料,患者均采用急诊PCI治疗,随访6个月,统计预后不良发生情况,比较不同预后患者的临床资料,并对AMI患者PCI术后预后相关因素进行Logistic多因素回归分析。结果:95例早发AMI患者中,PCI后预后不良发生率为28.42%(27/95)。预后不良组中多支血管病变、有吸烟史、合并高尿酸血症、心肌肌钙蛋白Ⅰ(cTnⅠ)水平>1.5μg/L、植入金属裸支架、首诊心率>76次/min、非ST段抬高型心肌梗死(NSTEMI)患者占比高于预后良好组,差异均有统计学意义(P<0.05);Logistic多因素回归分析发现,多支血管病变、有吸烟史、合并高尿酸血症、cTnⅠ水平>1.5μg/L、支架类型为金属裸支架、首诊心率>76次/min、NSTEMI均是导致AMI患者PCI术后预后不良的独立危险因素(OR>1,P<0.05)。结论:多支血管病变、有吸烟史、合并高尿酸血症、cTnⅠ水平>1.5μg/L、金属裸支架、首诊心率>76次/min、NSTEMI均是导致AMI患者PCI术后预后不良的独立危险因素,临床需采取针对性干预措施,以改善患者预后。

定量血流分数在老年急性ST段抬高心肌梗死非罪犯血管病变中的应用评价

目的 评价定量血流分数(quantitative flow ratio, QFR)指导老年ST段抬高急性心肌梗死(acute ST segment elevation myocardial infarction, STEMI)非罪犯血管病变(non-culprit lesion, NCL)血运重建的价值。方法 前瞻性入选STEMI合并多支病变(multivessel disease, MVD)老年患者,行急诊经皮冠脉介入治疗(percutaneous coronary intervention, PCI)后,将相关影像离线传输至QFR工作站进行分析,并根据急性期QFR结果决定是否择期对NCL进行血运重建,QFR≤0.80则处理NCL, QFR>0.80则进行强化药物治疗,择期干预时造影后再次行QFR测定,比较NCL急性期和择期造影时QFR结果的差异,所有入选患者通过电话和门诊随访,记录所有患者在术后1年时的主要心脏不良事件(major adverse cardiac events, MACE),包括:全因死亡,再发心梗,靶病变再次血运重建。结果 108例患者入选并完成了离线QFR检查,30例QFR≤0.80的患者的32支NCL血管行择期PCI治疗,75例QFR>0.80的患者接受强化药物治疗。对接受择期PCI的30例患者的32个病变血管,在择期介入时QFR检查结果和急诊时测得的QFR结果高度相关和一致(0.73±0.08)vs(0.73±0.09),r=0.94,平均差值(0.01±0.06)。以QFR≤0.80为标准,以定量冠脉造影(quantitative coronary angiography, QCA)直径狭窄≥70%来确定病变的功能性意义,其准确性仅75.9%。入选患者中107例(99.1%)完成了1年临床随访,QFR≤0.80患者中,1例患者(3.0%)发生非ST段抬高心肌梗死,1例患者(3.0%)行靶血管再次血运重建,QFR>0.80患者中,2例(1.3%)患者行靶血管再次血运重建。结论 QFR在急性心肌梗死急性期评价NCL病变的功能性意义是可行且准确的,QFR≤0.80来决定NCL是否干预是合理且安全的指标。在有限选择的人群当中,QFR可能成为日常指导老年急性ST段抬高心肌梗死非罪犯病变血运重建的安全可靠的工具。