BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore...BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.展开更多
BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary interven...BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.展开更多
Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC ...Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC and the prognosis for patients with ST-elevation myocardial infarction are not available.Methods Between January 2013 and December 2019,183 STEMI patients who attended in our center were retrospectively analyzed.All of the patients underwent primary percutaneous coronary intervention(PCI)and were with final TIMI grade 3 flow.Those patients were divided into high CTFC group(CTFC≥23 frames,n=76)and low CTFC group(CTFC<23 frames,n=107).The primary endpoint was the incidence of major adverse cardiovascular events(MACEs)after 12 months.Univariate and multivariate cox regression analysis was performed to figure out prognostic factors.Results A total of 183 individuals were included in this study.MACE rate was significantly higher in those patients with high CTFC(32.9%vs.15.7%,P=0.012),especially the revascularization rate(18.4%vs.2.8%,P=0.012).Multivariate Cox regression analysis showed that CTFC was the independent predictors of worse prognosis[risk ratio(RR):0.75,95%confidence interval(CI)0.67-0.82,P<0.001].Conclusions CTFC is feasible to identify the high-risk group after primary PCI for STEMI patients.High CTFC was associated with poor short-term clinical outcome.[S Chin J Cardiol 2021;22(1):7-12]展开更多
目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NG...目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、术后TIMI分级、TIMI记帧、和心肌blush分级以及术后一周内及3个月后左室射血分数(LVEF)。结果:两组全部病例均成功地置入支架,GW组全部成功放置GuardWire PlusTM保护装置,GW组ST段回落□50%的百分比明显高于NGW组(68．4%vs41．2%,p＜0．05)。术后TIMI分级两组没有明显差别,TIMI记帧(p=0．043)和心肌blush分级有明显差别(p=0．000)。GW组的左室射血分数(LVEF)明显高于NGW组。结论:急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。展开更多
Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to e...Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography(ICMCE),corrected thrombolysis in myocardial infarction frame count(CTFC),and coronary blood flow velocity(BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A(normal coronary artery),group B(75%–95%coronary artery stenosis),group C(coronary artery stenosis>95%)and group D(acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A(P<0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A(P<0.05),and there were significant differences in the three MCE parameters between group D and group A(P<0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments(P<0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly.Thus,the IC-MCE method is of great value to coronary artery disease(CAD)patients undergoing PCI,especially for those with acute myocardial infarction(AMI).展开更多
文摘BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.
基金supported by Zhejiang Natural ScienceFoundation (LY18H020007).
文摘BACKGROUND: Approximately 20% to 30% of patients with coronary artery disease (CAD)develop recurrent angina pectoris following successful and complete coronary revascularization utilizingpercutaneous coronary intervention (PCI). We aim to investigate predictors of recurrent angina pectorisin patients who have undergone successful coronary revascularization using PCI, but on repeat coronaryangiography have no need for secondary revascularization.METHODS: The study comprised 3,837 patients with CAD, who were enrolled from January2007 to June 2019. They had undergone successful PCI;some of them redeveloped anginapectoris within one year after the procedure, but on repeat coronary angiography had no need forrevascularization. Thrombolysis in myocardial infarction (TIMI) frame count was used to evaluatethe velocity of coronary blood in the follow-up angiogram. Multivariate logistic regression was usedto investigate risk factors for recurrent angina pectoris. Similarly, predictors of recurrent anginaaccording to the TIMI frame count were assessed using multivariate linear regression.RESULTS: In this retrospective study, 53.5% of patients experienced recurrent angina pectoris.By multivariate logistic regression, the following characteristics were statistically identified as riskfactors for recurrent angina pectoris: female sex, older age, current smoking, low-density lipoproteincholesterol (LDL-C) ≥1.8 mmol/L, and an elevated TIMI frame count (P for all <0.05). Similarly, usingmultivariate linear regression, the statistical risk factors for TIMI frame count included: female sex,older age, diabetes, body mass index (BMI), post-procedural treatment without the inclusion of dualantiplatelet therapy.CONCLUSIONS: Patient characteristics of female sex, older age, diabetes, and elevated BMIare associated with an increased TIMI frame count, coronary microcirculation dysfunction, and recurrentangina pectoris after initially successful PCI. In addition, current smoking and LDL-C ≥1.8 mmol/L arerisk factors for recurrent angina pectoris. In contrast, the treatment with dual antiplatelet therapy isnegatively correlated with a higher TIMI frame count and the risk of recurrent angina pectoris.
基金supported by The Second Batch of Shantou Medical and Health Science and Technology Plan(self-financing)projects in 2019[shanfuke(2019)No.70]
文摘Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC and the prognosis for patients with ST-elevation myocardial infarction are not available.Methods Between January 2013 and December 2019,183 STEMI patients who attended in our center were retrospectively analyzed.All of the patients underwent primary percutaneous coronary intervention(PCI)and were with final TIMI grade 3 flow.Those patients were divided into high CTFC group(CTFC≥23 frames,n=76)and low CTFC group(CTFC<23 frames,n=107).The primary endpoint was the incidence of major adverse cardiovascular events(MACEs)after 12 months.Univariate and multivariate cox regression analysis was performed to figure out prognostic factors.Results A total of 183 individuals were included in this study.MACE rate was significantly higher in those patients with high CTFC(32.9%vs.15.7%,P=0.012),especially the revascularization rate(18.4%vs.2.8%,P=0.012).Multivariate Cox regression analysis showed that CTFC was the independent predictors of worse prognosis[risk ratio(RR):0.75,95%confidence interval(CI)0.67-0.82,P<0.001].Conclusions CTFC is feasible to identify the high-risk group after primary PCI for STEMI patients.High CTFC was associated with poor short-term clinical outcome.[S Chin J Cardiol 2021;22(1):7-12]
文摘目的:评价在急性心肌梗死(AMI)的经皮冠脉介入治疗(PCI)过程中,应用远端保护装置Guard Wire Plus TM的安全性及有效性。方法:自2004年9月至2006年5月共72例急性心肌梗死接受急诊PCI治疗的患者随机分为远端保护组(GW组)和非远端保护组(NGW组),其中GW组38例,NGW组34例。比较两组间的基础临床状况、造影情况、ST段回落情况、术后TIMI分级、TIMI记帧、和心肌blush分级以及术后一周内及3个月后左室射血分数(LVEF)。结果:两组全部病例均成功地置入支架,GW组全部成功放置GuardWire PlusTM保护装置,GW组ST段回落□50%的百分比明显高于NGW组(68．4%vs41．2%,p＜0．05)。术后TIMI分级两组没有明显差别,TIMI记帧(p=0．043)和心肌blush分级有明显差别(p=0．000)。GW组的左室射血分数(LVEF)明显高于NGW组。结论:急性心肌梗死急诊PCI中联合应用远端保护装置可以有效的预防远端血栓栓塞,缩小梗死面积,改善LVEF。
文摘Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease(CAD)after they have undergone percutaneous coronary intervention(PCI).The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography(ICMCE),corrected thrombolysis in myocardial infarction frame count(CTFC),and coronary blood flow velocity(BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI.For the study sixty-eight patients were divided into four groups based on selective coronary angiography results:group A(normal coronary artery),group B(75%–95%coronary artery stenosis),group C(coronary artery stenosis>95%)and group D(acute total coronary occlusion).The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI.IC-MCE was also performed before PCI in group D.The quantitative parameters of MCE involved:contrast peak intensity,time to peak intensity and area under the curve,representing myocardial blood volume,reperfusion velocity and myocardial blood flow,respectively.No difference was found in CTFC between the coronary artery stenosis group and the normal group.BFV was slower in group D than in group A(P<0.05).The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A(P<0.05),and there were significant differences in the three MCE parameters between group D and group A(P<0.05).For those patients with acute or total occlusion,the levels of myocardial perfusion before and after PCI were similar,as determined by IC-MCE and visually analyzed from 61 segments(P<0.05).Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods.Moreover,with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly.Thus,the IC-MCE method is of great value to coronary artery disease(CAD)patients undergoing PCI,especially for those with acute myocardial infarction(AMI).
