Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a n...Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.展开更多
目的观察早期应用普通肝素在行急诊直接经皮冠状动脉介入术(pPCI)治疗的急性ST段抬高型心肌梗死(ASTEMI)患者中的应用效果。方法将行急诊pPCI治疗的161例ASTEMI患者随机分为早期组78例与常规组83例。早期组患者在确诊ASTEMI后立即给予...目的观察早期应用普通肝素在行急诊直接经皮冠状动脉介入术(pPCI)治疗的急性ST段抬高型心肌梗死(ASTEMI)患者中的应用效果。方法将行急诊pPCI治疗的161例ASTEMI患者随机分为早期组78例与常规组83例。早期组患者在确诊ASTEMI后立即给予普通肝素治疗,常规组患者则在动脉穿刺成功后给予等量普通肝素治疗。比较两组患者的临床相关指标(术后ST段回落率、术后肌钙蛋白T峰值)、pPCI相关指标[pPCI术后即刻的心肌梗死溶栓治疗(TIMI)血流分级3级比例、TIMI心肌灌注分级(TMPG)3级比例]、术后30 d主要心血管不良事件(MACE)的发生率,以及出院前、术后12周的心脏彩超指标[左心室舒张末期内径、左心室射血分数、左心室舒张早期与舒张晚期二尖瓣血流速度比值(E/A)、左心室整体纵向应变(GLS)]。结果两组患者术后即刻TIMI血流分级3级和TMPG 3级比例,以及肌钙蛋白T峰值、院内出血的发生率、术后30 d MACE的发生率比较,差异均无统计学意义(均P>0.05),而早期组术后心电图ST段回落率高于常规组(P<0.05)。出院前两组心脏彩超指标差异无统计学意义;而术后12周,早期组E/A和左心室GLS均高于常规组(均P<0.05)。结论发病早期给予普通肝素治疗可以更好地提高行急诊pPCI治疗的ASTEMI患者的心电图ST段回落率,改善心肌灌注及心室功能。展开更多
目的探讨1期支架置入和延期支架置入对高血栓负荷急性ST段抬高性心肌梗死(STEMI)患者QTc离散度、心肌灌注的影响。方法选取2019年9月至2021年2月保定市第二医院收治的80例高血栓负荷STEMI患者,根据随机数字表法分为1期组和延期组,各40...目的探讨1期支架置入和延期支架置入对高血栓负荷急性ST段抬高性心肌梗死(STEMI)患者QTc离散度、心肌灌注的影响。方法选取2019年9月至2021年2月保定市第二医院收治的80例高血栓负荷STEMI患者,根据随机数字表法分为1期组和延期组,各40例。两组均行经皮冠状动脉介入术(PCI),1期组术中采用1期支架置入,延期组术中采用延期支架置入。统计两组支架置入后2 h ST段回落指数、QTc离散度(QTcd)、校正QT间期(QTc)、冠状动脉血流情况、心肌灌注、血栓积分、血小板计数(PLT)、D-二聚体(D-D)、微小RNA-302b(miR-302b)、B型钠尿肽(BNP)、PCI情况,并随访主要心血管不良事件(MACE)。结果支架置入后2 h延期组QTcd(40.33±3.39)ms、QTc(42.30±5.51)ms低于1期组(55.15±4.06)ms、(58.82±5.17)ms,差值(27.68±5.15)、(28.03±4.89)高于1期组(11.84±4.48)、(12.63±3.95)(P<0.05),支架置入后2 h ST段回落指数高于1期组(P<0.05);支架置入后2 h延期组冠状动脉血流情况优于1期组(P<0.05);支架置入后2 h延期组血栓积分(2.41±0.16)分低于1期组(2.58±0.23)分,心肌灌注积分(2.65±0.11)分高于1期组(2.50±0.12)分,差值(0.81±0.04)分、(1.63±0.15)分大于1期组(0.58±0.05)分、(1.47±0.10)分(P<0.05);支架置入后2 h两组miR-302b、BNP水平低于支架置入前(P<0.05),支架置入后2 h延期组PLT(125.56±15.51)×10^(9)/L、D-D(0.40±0.08)mg/L水平低于1期组(182.33±17.65)×10^(9)/L、D-D(0.52±0.10)mg/L(P<0.05);延期组无复流/慢血流发生率17.50%低于1期组(40.00%,P<0.05);术后1个月随访,两组均无脱落病例。两组MACE发生率比较,差异无统计学意义(P>0.05)。结论延期支架置入有助于降低高血栓负荷STEMI患者QTcd,改善心肌灌注,抑制血栓形成,减少无复流/慢血流发生率。展开更多
基金funded by the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program (No.2011BAI11B05)Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2019_014226_000023)
文摘Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.
文摘目的观察早期应用普通肝素在行急诊直接经皮冠状动脉介入术(pPCI)治疗的急性ST段抬高型心肌梗死(ASTEMI)患者中的应用效果。方法将行急诊pPCI治疗的161例ASTEMI患者随机分为早期组78例与常规组83例。早期组患者在确诊ASTEMI后立即给予普通肝素治疗,常规组患者则在动脉穿刺成功后给予等量普通肝素治疗。比较两组患者的临床相关指标(术后ST段回落率、术后肌钙蛋白T峰值)、pPCI相关指标[pPCI术后即刻的心肌梗死溶栓治疗(TIMI)血流分级3级比例、TIMI心肌灌注分级(TMPG)3级比例]、术后30 d主要心血管不良事件(MACE)的发生率,以及出院前、术后12周的心脏彩超指标[左心室舒张末期内径、左心室射血分数、左心室舒张早期与舒张晚期二尖瓣血流速度比值(E/A)、左心室整体纵向应变(GLS)]。结果两组患者术后即刻TIMI血流分级3级和TMPG 3级比例,以及肌钙蛋白T峰值、院内出血的发生率、术后30 d MACE的发生率比较,差异均无统计学意义(均P>0.05),而早期组术后心电图ST段回落率高于常规组(P<0.05)。出院前两组心脏彩超指标差异无统计学意义;而术后12周,早期组E/A和左心室GLS均高于常规组(均P<0.05)。结论发病早期给予普通肝素治疗可以更好地提高行急诊pPCI治疗的ASTEMI患者的心电图ST段回落率,改善心肌灌注及心室功能。
文摘目的探讨1期支架置入和延期支架置入对高血栓负荷急性ST段抬高性心肌梗死(STEMI)患者QTc离散度、心肌灌注的影响。方法选取2019年9月至2021年2月保定市第二医院收治的80例高血栓负荷STEMI患者,根据随机数字表法分为1期组和延期组,各40例。两组均行经皮冠状动脉介入术(PCI),1期组术中采用1期支架置入,延期组术中采用延期支架置入。统计两组支架置入后2 h ST段回落指数、QTc离散度(QTcd)、校正QT间期(QTc)、冠状动脉血流情况、心肌灌注、血栓积分、血小板计数(PLT)、D-二聚体(D-D)、微小RNA-302b(miR-302b)、B型钠尿肽(BNP)、PCI情况,并随访主要心血管不良事件(MACE)。结果支架置入后2 h延期组QTcd(40.33±3.39)ms、QTc(42.30±5.51)ms低于1期组(55.15±4.06)ms、(58.82±5.17)ms,差值(27.68±5.15)、(28.03±4.89)高于1期组(11.84±4.48)、(12.63±3.95)(P<0.05),支架置入后2 h ST段回落指数高于1期组(P<0.05);支架置入后2 h延期组冠状动脉血流情况优于1期组(P<0.05);支架置入后2 h延期组血栓积分(2.41±0.16)分低于1期组(2.58±0.23)分,心肌灌注积分(2.65±0.11)分高于1期组(2.50±0.12)分,差值(0.81±0.04)分、(1.63±0.15)分大于1期组(0.58±0.05)分、(1.47±0.10)分(P<0.05);支架置入后2 h两组miR-302b、BNP水平低于支架置入前(P<0.05),支架置入后2 h延期组PLT(125.56±15.51)×10^(9)/L、D-D(0.40±0.08)mg/L水平低于1期组(182.33±17.65)×10^(9)/L、D-D(0.52±0.10)mg/L(P<0.05);延期组无复流/慢血流发生率17.50%低于1期组(40.00%,P<0.05);术后1个月随访,两组均无脱落病例。两组MACE发生率比较,差异无统计学意义(P>0.05)。结论延期支架置入有助于降低高血栓负荷STEMI患者QTcd,改善心肌灌注,抑制血栓形成,减少无复流/慢血流发生率。
