Objective: To investigate the regulation of High sensitive C-reactive protein(Hs-CRP) and WBC count in patients with coronary heart disease(CHD) by percutaneous transluminal intervention(PCI) and to discuss the...Objective: To investigate the regulation of High sensitive C-reactive protein(Hs-CRP) and WBC count in patients with coronary heart disease(CHD) by percutaneous transluminal intervention(PCI) and to discuss the mechanism of inflammatory reaction after coronary stenting. Methods:127 patients who received successful percutaneous transluminal coronary stenting, were divided into groups of stable angina(SAP), unstable angina(UAP), and acute myocardial infarction(AMI) according to their clinical types. Another 41 stable angina patients with more than 70% of coronary artery tenosis who did not receive PCI served as control. Serum Hs-CRP levels and WBC count were determined before intervention, 3 days and 7 days post PCI and the data were analyzed statistically by t-test. Results: There showed no difference in clinical baseline characteristics between groups. The serum Hs-CRP level and WBC count was gradually raised in the UAP and AMI group(how about SAP group, andhad no difference in CAG group and SAP group). After PCI serum HsCRP levels and WBC counts were significantly higher in the SAP group than in the coronary angiography group(CAG) at 3 days and had no difference at 7 days. In the UAP and AMI group, the serum Hs-CRP level at 3 days and 7 days declined obviously, however serum WBC count did not decrease apparently. Conclusion: The serum Hs-CRP level and WBC count elevate transiently after PCI. There are different inflammatory reactions in different types of coronary heart diseases after coronary stenting procedure.展开更多
目的确定心肺运动试验(CPET)参数中与PCI术后存在焦虑的冠心病患者5年内死亡事件相关的独立危险因素,并建立此类人群5年死亡事件发生的预测模型。方法选取2015年10月~2021年9月北部战区总医院心血管内科因确诊冠心病(CAD)行PCI手术,且...目的确定心肺运动试验(CPET)参数中与PCI术后存在焦虑的冠心病患者5年内死亡事件相关的独立危险因素,并建立此类人群5年死亡事件发生的预测模型。方法选取2015年10月~2021年9月北部战区总医院心血管内科因确诊冠心病(CAD)行PCI手术,且在出院前完成CPET的焦虑患者(GAD-7评分≥5)作为研究对象,最终符合条件共868例,其中根据5年内随访是否死亡分为死亡组17例,无事件组851例。应用单因素及多因素分析筛选出与5年死亡率相关的独立危险因素,建立Logistic回归模型,分别通过绘制受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验来评价预测模型预测效能和适配度。结果用力肺活量占预测百分比(FVC%)、二氧化碳通气当量的最小值(VE/VCO2min)和运动后心率恢复(HRR)(均P<0.05)等三个CPET参数是PCI术后存在焦虑的冠心病患者5年死亡风险独立危险因素。绘制ROC曲线,曲线下面积(area under curve,AUC)为0.795。Hosmer-Lemeshowχ2=7.396,P=0.495>0.1。结论尽管焦虑情绪对CPET结果的客观性存在一定影响,但个别CPET参数对PCI术后存在焦虑的冠心病患者的5年死亡事件的发生仍具有预测能力,这些参数在发生死亡事件的人群中明显趋向不良。展开更多
目的:目前冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI),前向或逆向技术的关键和难点均在于使导丝通过病变至远端血管真腔。本研究报道一种血管内超声指导的真腔寻径与跟踪(IVUS-TST)的前向新技术,用于前向治疗复...目的:目前冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI),前向或逆向技术的关键和难点均在于使导丝通过病变至远端血管真腔。本研究报道一种血管内超声指导的真腔寻径与跟踪(IVUS-TST)的前向新技术,用于前向治疗复杂CTO病变!戈介入失败的患者。方法:总结2013-01-01至2013-12-31同一介入术者所完成的全部CTO病例,分为造影引导组(n=49)和IVUS-TST组(n=67)两组,对比成功率、并发症率并分析失败原因。复杂CTO病变定义为日本J-CTO评分≥1分。介入成功定义为经对侧造影或血管内超声(IVUS)证实的导丝位于闭塞段远端真腔,至少完成了球囊扩张治疗。结果:140例患者148个CTO病变中,去除32例32个简单CTO病变(J-CTO评分〈1分,PCI成功率100%)后,共108例患者[男性90例,女性18例,平均年龄(56.71±11.89)岁]的116个复杂CTO病变[J-CTO评分平均为(2.18±0.80)分]纳入分析。与造影引导组相比,IVUS-TST组J-CTO评分显著更高[(2.33±0.84)分VS(1.98±0.69)分,P=0.019],病变显著更长(37.99±22.51)mm vs(31.43±20.20)mm,P=0.034],差异均有统计学意义。两组相比,IVUS-TST组较造影引导组PCI成功率有提高趋势(65.7%VS49.0%,P=0.071);冠状动脉穿孔(9.0%V818.4%,P=0.136)和窦部损伤(0% vs 6.1%,P=0.073)比例也有降低趋势,但差异无统计学意义。所有患者均无住院死亡或行急诊冠状动脉旁路移植手术。多因素回归分析显示,IVUS-TST技术(比值比=2.756,95%可信区间1.019-7.453,P=0.046)是提高复杂CTO介入治疗成功的独立预测因素。复杂CTO介入失败的主要原因为导丝入口即进入假腔(43.8%)或不能再穿入真腔(43.8%);IVUS-TST技术的优势在于能使导丝从入口直接穿进真腔(33.8%),或引导内膜下导丝再穿入真腔(35.3%)。结论:以真腔为目标的][VUS-TST技术是一种有效治疗复杂CTO病变的新方法,可望提高手术成功率,减少严重并发症发生。展开更多
目的探讨老年冠心病患者经桡动脉行PCI的可行性和安全性。方泼选择709例老年(年龄≥75岁)冠心病患者,根据患者接受PCI的入路途径不同,分为桡动脉组(227例)和股动脉组(482例),比较两组患者临床基线PCI的成功率、造影剂用量、手术时间、...目的探讨老年冠心病患者经桡动脉行PCI的可行性和安全性。方泼选择709例老年(年龄≥75岁)冠心病患者,根据患者接受PCI的入路途径不同,分为桡动脉组(227例)和股动脉组(482例),比较两组患者临床基线PCI的成功率、造影剂用量、手术时间、并发症的发生率以及术后6个月时发生严重心脏不良事件的情况。结果桡动脉组血脂异常患者的比例高于股动脉组(P<0.05)。桡动脉组手术成功率为97.8%,股动脉组患者全部成功接受PCI。两组手术时间和造影剂用量比较,差异无统计学意义,桡动脉组3例(1.3%)患者出现血管并发症,股动脉组27例(5.6%)出现并发症,两组比较差异有统计学意义(P<0.05),桡动脉组和股动脉组患者术后6个月时严重心脏不良事件的发生率比较,差异无统计学意义(8.4% vs 7.3%,P>0.05)。结论老年冠心病患者经桡动脉行PCI具有良好的可行性和安全性。展开更多
文摘Objective: To investigate the regulation of High sensitive C-reactive protein(Hs-CRP) and WBC count in patients with coronary heart disease(CHD) by percutaneous transluminal intervention(PCI) and to discuss the mechanism of inflammatory reaction after coronary stenting. Methods:127 patients who received successful percutaneous transluminal coronary stenting, were divided into groups of stable angina(SAP), unstable angina(UAP), and acute myocardial infarction(AMI) according to their clinical types. Another 41 stable angina patients with more than 70% of coronary artery tenosis who did not receive PCI served as control. Serum Hs-CRP levels and WBC count were determined before intervention, 3 days and 7 days post PCI and the data were analyzed statistically by t-test. Results: There showed no difference in clinical baseline characteristics between groups. The serum Hs-CRP level and WBC count was gradually raised in the UAP and AMI group(how about SAP group, andhad no difference in CAG group and SAP group). After PCI serum HsCRP levels and WBC counts were significantly higher in the SAP group than in the coronary angiography group(CAG) at 3 days and had no difference at 7 days. In the UAP and AMI group, the serum Hs-CRP level at 3 days and 7 days declined obviously, however serum WBC count did not decrease apparently. Conclusion: The serum Hs-CRP level and WBC count elevate transiently after PCI. There are different inflammatory reactions in different types of coronary heart diseases after coronary stenting procedure.
文摘目的确定心肺运动试验(CPET)参数中与PCI术后存在焦虑的冠心病患者5年内死亡事件相关的独立危险因素,并建立此类人群5年死亡事件发生的预测模型。方法选取2015年10月~2021年9月北部战区总医院心血管内科因确诊冠心病(CAD)行PCI手术,且在出院前完成CPET的焦虑患者(GAD-7评分≥5)作为研究对象,最终符合条件共868例,其中根据5年内随访是否死亡分为死亡组17例,无事件组851例。应用单因素及多因素分析筛选出与5年死亡率相关的独立危险因素,建立Logistic回归模型,分别通过绘制受试者工作特征(ROC)曲线和Hosmer-Lemeshow拟合优度检验来评价预测模型预测效能和适配度。结果用力肺活量占预测百分比(FVC%)、二氧化碳通气当量的最小值(VE/VCO2min)和运动后心率恢复(HRR)(均P<0.05)等三个CPET参数是PCI术后存在焦虑的冠心病患者5年死亡风险独立危险因素。绘制ROC曲线,曲线下面积(area under curve,AUC)为0.795。Hosmer-Lemeshowχ2=7.396,P=0.495>0.1。结论尽管焦虑情绪对CPET结果的客观性存在一定影响,但个别CPET参数对PCI术后存在焦虑的冠心病患者的5年死亡事件的发生仍具有预测能力,这些参数在发生死亡事件的人群中明显趋向不良。
文摘目的:目前冠状动脉慢性完全闭塞(CTO)病变经皮冠状动脉介入治疗(PCI),前向或逆向技术的关键和难点均在于使导丝通过病变至远端血管真腔。本研究报道一种血管内超声指导的真腔寻径与跟踪(IVUS-TST)的前向新技术,用于前向治疗复杂CTO病变!戈介入失败的患者。方法:总结2013-01-01至2013-12-31同一介入术者所完成的全部CTO病例,分为造影引导组(n=49)和IVUS-TST组(n=67)两组,对比成功率、并发症率并分析失败原因。复杂CTO病变定义为日本J-CTO评分≥1分。介入成功定义为经对侧造影或血管内超声(IVUS)证实的导丝位于闭塞段远端真腔,至少完成了球囊扩张治疗。结果:140例患者148个CTO病变中,去除32例32个简单CTO病变(J-CTO评分〈1分,PCI成功率100%)后,共108例患者[男性90例,女性18例,平均年龄(56.71±11.89)岁]的116个复杂CTO病变[J-CTO评分平均为(2.18±0.80)分]纳入分析。与造影引导组相比,IVUS-TST组J-CTO评分显著更高[(2.33±0.84)分VS(1.98±0.69)分,P=0.019],病变显著更长(37.99±22.51)mm vs(31.43±20.20)mm,P=0.034],差异均有统计学意义。两组相比,IVUS-TST组较造影引导组PCI成功率有提高趋势(65.7%VS49.0%,P=0.071);冠状动脉穿孔(9.0%V818.4%,P=0.136)和窦部损伤(0% vs 6.1%,P=0.073)比例也有降低趋势,但差异无统计学意义。所有患者均无住院死亡或行急诊冠状动脉旁路移植手术。多因素回归分析显示,IVUS-TST技术(比值比=2.756,95%可信区间1.019-7.453,P=0.046)是提高复杂CTO介入治疗成功的独立预测因素。复杂CTO介入失败的主要原因为导丝入口即进入假腔(43.8%)或不能再穿入真腔(43.8%);IVUS-TST技术的优势在于能使导丝从入口直接穿进真腔(33.8%),或引导内膜下导丝再穿入真腔(35.3%)。结论:以真腔为目标的][VUS-TST技术是一种有效治疗复杂CTO病变的新方法,可望提高手术成功率,减少严重并发症发生。
文摘目的探讨老年冠心病患者经桡动脉行PCI的可行性和安全性。方泼选择709例老年(年龄≥75岁)冠心病患者,根据患者接受PCI的入路途径不同,分为桡动脉组(227例)和股动脉组(482例),比较两组患者临床基线PCI的成功率、造影剂用量、手术时间、并发症的发生率以及术后6个月时发生严重心脏不良事件的情况。结果桡动脉组血脂异常患者的比例高于股动脉组(P<0.05)。桡动脉组手术成功率为97.8%,股动脉组患者全部成功接受PCI。两组手术时间和造影剂用量比较,差异无统计学意义,桡动脉组3例(1.3%)患者出现血管并发症,股动脉组27例(5.6%)出现并发症,两组比较差异有统计学意义(P<0.05),桡动脉组和股动脉组患者术后6个月时严重心脏不良事件的发生率比较,差异无统计学意义(8.4% vs 7.3%,P>0.05)。结论老年冠心病患者经桡动脉行PCI具有良好的可行性和安全性。