BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between fr...BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.展开更多
BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary pe...BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.展开更多
Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article revie...Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article reviews the current status and influencing factors of postoperative depression after PCI and summarizes the corresponding nursing interventions,to provide a literature reference to implement effective nursing interventions for depressed patients after clinical PCI.展开更多
Objective: To examine physical activity(PA) of post-percutaneous coronary intervention(PCI) patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: ...Objective: To examine physical activity(PA) of post-percutaneous coronary intervention(PCI) patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: A total of 246 post-PCI patients from the Peking University Third Hospital in Beijing, China, were included in this crosssectional study through convenience sampling. Data were collected from a self-repor ted questionnaire. PA was categorized into low, moderate, or high levels. The ordinal multinomial logistic regression model was used to estimate the relationship among demographic, medical, and psychosocial characteristics. Results: The overall prevalence of low, moderate, and high PA was 20%, 70%, and 10%, respectively. For the domain-specific PA patterns, most par ticipants took par t in leisure-time PA(84.5%);walking was the most common PA. Increased motivation and selfefficacy, lower monthly income, and unemployment were predictors of high PA. Conclusions: PA levels in post-PCI patients was not optimal, and leisure-time PA had the highest par ticipation rate. Analyses of influencing factors can provide medical staff and health workers information to focus on high-risk groups and introduce more tailored interventions. Future studies can explore more regions, and ecological models can be introduced to study more influencing factors.展开更多
With advances in the field of interventional cardiology,percutaneous coronary intervention(PCI)has become one of the main treatment methods for patients with coronary artery disease in clinical practice.^([1])Routine ...With advances in the field of interventional cardiology,percutaneous coronary intervention(PCI)has become one of the main treatment methods for patients with coronary artery disease in clinical practice.^([1])Routine interventional therapy is performed under fluoroscopic guidance,and interventional cardiologists are therefore often exposed to radiation.As a result,the risks of cancer,cataract,hair loss and loss of skin pigmentation will be significantly incre-ased after long-term radiation exposure.展开更多
Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,...Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases,and publish articles on the correlation between hyperuricemia and contrast agent-related acute kidney damage after percutaneous coronary intervention from the establishment of the database to August 162023.Two researchers independently conducted literature screening and data extraction to evaluate the bias risk of inclusion in the study,and conducted metaanalysis using Review Manager 5.4 software.Results:A total of 12 articles were included,including 11676 patients.The meta-analysis results showed that compared with patients without hyperuricemia,patients with hyperuricemia had a higher risk of developing PC-AKI,with an incidence rate of 22.3%.Hyperuricemia was a risk factor for the occurrence of PCAKI(OR=2.03,95%CI:1.58-2.61);Patients with hyperuricemia have a higher risk of death after PC-AKI,with a mortality rate of 7.5%.Hyperuricemia is a risk factor for early death in PC-AKI patients(OR=2.33,95%CI:1.81-3.00);The probability of CRRT treatment after PCAKI in patients with hyperuricemia is higher,at 3.14%.Hyperuricemia is an influencing factor for CRRT treatment in PC-AKI patients(OR=7,95%CI:2.83-17.30).Conclusion:Existing research evidence suggests that the presence of hyperuricemia is an independent risk factor for the occurrence of PC-AKI,and it significantly increases the hospital mortality rate and the risk of renal replacement therapy in PC-AKI patients.展开更多
Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(...Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.展开更多
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 re...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.展开更多
Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repai...Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.展开更多
Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct siz...Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.展开更多
BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The prese...BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interval(CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours(OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg(OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI(OR= 1.949, 95%CI 1.168–3.253, P=0.011), low(≤1) TIMI fl ow grade before primary PCI(OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden(OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion(OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-refl ow.CONCLUSION: The occurrence of no-refl ow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.展开更多
We performed a meta-analysis of randomized controlled trials(RCTs) to investigate the efficacy and safety of ticagrelor(TIC) vs. clopidogrel(CLO) in patients undergoing percutaneous coronary intervention(PCI). In Jun ...We performed a meta-analysis of randomized controlled trials(RCTs) to investigate the efficacy and safety of ticagrelor(TIC) vs. clopidogrel(CLO) in patients undergoing percutaneous coronary intervention(PCI). In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality(MD=0.83, 95%CI=0.74–0.93, P=0.001) and myocardial infarction(MI)(MD=0.78, 95%CI=0.70–0.88, P=0.000). There were no significant differences in stroke(MD=1.34, 95%CI=0.99–1.79, P=0.06), total bleeding(MD=0.97, 95%CI=0.84–1.12, P=0.66), minor or major bleeding(MD=1.06, 95%CI=0.94–1.19, P=0.35) in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.展开更多
Background There are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention(PCI). Furthermore, gender differences in clinical outcomes with acute myocardial...Background There are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention(PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction(AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials. Methods A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health(KAMIR-NIH) between November 2011 and December 2015 were classified into male(n = 8021, 75.9%) and female(n = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events(MACCE) in women with those in men after AMI by using propensity score(PS) matching. Results Compared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction(NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population(30-days MACCE: 5.3% vs. 4.7%, log-rank P = 0.494, HR = 1.126, 95% CI: 0.800-1.585;1-year MACCE: 9.3% vs. 9.0%, log-rank P = 0.803, HR = 1.032, 95% CI: 0.802-1.328;TIMI minor bleeding: 4.9% vs. 3.9%, log-rank P = 0.215, HR = 1.255, 95% CI: 0.869-1.814). Conclusions Among Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.展开更多
BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whe...BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.展开更多
AIM To investigate the rates and determinants of success of repeat percutaneous coronary intervention(PCI) following an initial failed attempt at recanalising the chronic total occlusions(CTO) percutaneously.METHODS I...AIM To investigate the rates and determinants of success of repeat percutaneous coronary intervention(PCI) following an initial failed attempt at recanalising the chronic total occlusions(CTO) percutaneously.METHODS In 445 consecutive first attempt CTO-PCI procedures in our institution,procedural failure occurred in 149(33.5%). Sixty-four re-PCI procedures were performed in 58 patients(39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical,angiographic and procedural data was performed. RESULTS Procedural success was achieved in 41(64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound(IVUS) guidance(19.5% vs 0%,P = 0.042),while failure was associated with severecalcification(30.4% vs 9.7%,P = 0.047) and a JCTO score > 3(56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity(J-CTO score > 3),IVUS use,involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low,with the only MACCE two periprocedural MI's neither of which required intervention. CONCLUSION Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS,the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.展开更多
Purpose:To compare the effectiveness of the interventional limb raising management strategy(ILRMS)to elastic bandage compression at radial vascular access sites following coronary angiographies(CAGs)and percutaneous c...Purpose:To compare the effectiveness of the interventional limb raising management strategy(ILRMS)to elastic bandage compression at radial vascular access sites following coronary angiographies(CAGs)and percutaneous coronary interventions(PCIs).Methods:Patients with ischemic coronary heart disease whose condition was stable over three months were enrolled in this clinical study(n=590;aged 25e80).All participants had just undergone CAG and PCI.Patients were randomized into either the ILRMS group(n=360)or standard post-intervention care with an elastic bandage(n=230).Overall comfort and wrist pain was assessed and the degree of index finger swelling and oxygen saturation was measured on the affected arm.All variables were measured prior to postintervention treatment and again at six hours after CAG and PCI.Results:We found that patients receiving ILRMS had significantly lower wrist pain scores and swelling around the index finger compared to the elastic bandage group(p<0.05).Oxygen saturation of the index finger was not statistically significant(p>0.05).We also found that 19.57%of the elastic bandage patients were comfortable,while ILRMS patients were significantly more comfortable(93.06%;p<0.05).Conclusions:We find that ILRMS alleviates swelling and pain of the wrist more effectively than current practices and improves the degree of overall comfort of patients who undergo CAG and PCI.展开更多
Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases wit...Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.展开更多
Objective The alpha 2A‐adrenergic receptor gene(ADRA2A) polymorphism in individuals modifies the antiplatelet response to sympathetic stimulation. The aim of this study was to investigate the effect of ADRA2A variant...Objective The alpha 2A‐adrenergic receptor gene(ADRA2A) polymorphism in individuals modifies the antiplatelet response to sympathetic stimulation. The aim of this study was to investigate the effect of ADRA2A variants on platelet reactivity in Chinese patients on dual antiplatelet therapy(DAPT) after undergoing percutaneous coronary intervention(PCI).Methods From March 2011 to March 2013, 1,024 patients were enrolled in this prospective,single‐center, observational study in China. Four single nucleotide polymorphisms(SNPs) of ADRA2A gene(rs11195419, rs3750625, rs13306146, and rs553668) and CYP2 C19*2 were detected by ligase detection reaction(LDR), and adenosine diphosphate(ADP) inhibition was detected by thromboelastography(TEG~?).Results The minor allele frequencies of ADRA2A SNPs were common. Platelet ADP inhibition was significantly different among patients carrying rs11195419(adjusted P = 0.022) and rs3750625(adjusted P = 0.016). The homozygous allele carriers had the lowest ADP inhibition. However, ADP inhibition was not significantly different in rs553668 and rs13306146. At the multivariate analysis, rs11195419(P =0.033), rs3750625(P = 0.020) and CYP2 C19*2(P = 0.002) were independent predictors of ADP inhibition. Subgroups analysis based on sex showed rs11195419(P = 0.003) and rs3750625(P = 0.002)were significantly associated with ADP inhibition in males, but not in females.Conclusion ADRA2A genetic variations were associated with ADP‐induced platelet aggregation during DAPT in Chinese patients undergoing PCI, and the effect was particularly more pronounced in males.展开更多
Objective To evaluate the effects and mechanisms of glucose-insulin-potassium(GIK)on post-procedural myocardial injury(PMI)after percutaneous coronary intervention(PCI).Methods A total of 200 non-diabetic patients wit...Objective To evaluate the effects and mechanisms of glucose-insulin-potassium(GIK)on post-procedural myocardial injury(PMI)after percutaneous coronary intervention(PCI).Methods A total of 200 non-diabetic patients with documented coronary heart disease(CHD)were divided into the Group GIK and Group G,with 100 patients in each group.Patients in Group G were given intravenous infusion of glucose solution 2 hours before PCI.As compared,patients in Group GIK were given GIK.Results Both post-procedural creatine phosphokinase isoenzyme MB(CK-MB;62.1±47.8 vs.48.8±52.6 U/L,P=0.007)and cTnI(0.68±0.83 vs.0.19±0.24 ng/mL,P<0.001)in Group GIK were significantly higher than those in Group G.In Group G,9.0%and 4.0%of patients had post-procedural increases in CK-MB 1-3 times and>3 times,which were significantly lower than those in Group GIK(14.0%and 7.0%,respectively;all P values<0.01);13.0%and 7.0%of patients had post-procedural increases in cTnI 1-3 times and>3 times,which were also significantly lower than those in Group GIK(21.0%and 13.0%,respectively;all P<0.001).Pre-procedural(10.2±4.5 vs.5.1±6.3,P<0.001)and post-procedural rapid blood glucose(RBG)levels(8.9±3.9 vs.5.3±5.6,P<0.001)in Group G were higher than those in Group GIK.In adjusted logistic models,usage of GIK(compared with glucose solution)remained significantly and independently associated with higher risk of post-procedural increases in both CK-MB and cTnI levels>3 times.Furthermore,pre-procedural RBG levels<5.0mmol/L were significantly associated with higher risk of post-procedural increases in both CK-MB and cTnI levels.Conclusions In non-diabetic patients with CHD,the administration of GIK may increase the risk of PMI due to hypoglycemia induced by GIK.展开更多
BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI ther...BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.展开更多
文摘BACKGROUND Frailty is a common condition in elderly patients who receive percutaneous coronary intervention(PCI).However,how frailty affects clinical outcomes in this group is unclear.AIM To assess the link between frailty and the outcomes,such as in-hospital complic-ations,post-procedural complications,and mortality,in elderly patients post-PCI.METHODS The PubMed/MEDLINE,EMBASE,Cochrane Library,and Web of Science databases were screened for publications up to August 2023.The primary outcomes assessed were in-hospital and all-cause mortality,major adverse cardiovascular events(MACEs),and major bleeding.The Newcastle-Ottawa Scale was used for quality assessment.RESULTS Twenty-one studies with 739693 elderly patients undergoing PCI were included.Frailty was consistently associated with adverse outcomes.Frail patients had significantly higher risks of in-hospital mortality[risk ratio:3.45,95%confidence interval(95%CI):1.90-6.25],all-cause mortality[hazard ratio(HR):2.08,95%CI:1.78-2.43],MACEs(HR:2.92,95%CI:1.85-4.60),and major bleeding(HR:4.60,95%CI:2.89-7.32)compared to non-frail patients.CONCLUSION Frailty is a pivotal determinant in the prediction of risk of mortality,development of MACEs,and major bleeding in elderly individuals undergoing percutaneous coronary intervention.
文摘BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.
基金Xianyang City Key R&D Plan Project(No.:L 2022ZDYFSF004)。
文摘Percutaneous coronary intervention(PCI)is an effective treatment method for myocardial ischemic necrosis.Postoperative depression caused by PCI stress will adversely affect the prognosis of patients.This article reviews the current status and influencing factors of postoperative depression after PCI and summarizes the corresponding nursing interventions,to provide a literature reference to implement effective nursing interventions for depressed patients after clinical PCI.
文摘Objective: To examine physical activity(PA) of post-percutaneous coronary intervention(PCI) patients and explore the demographic, clinical, and social psychological characteristics associated with PA levels. Methods: A total of 246 post-PCI patients from the Peking University Third Hospital in Beijing, China, were included in this crosssectional study through convenience sampling. Data were collected from a self-repor ted questionnaire. PA was categorized into low, moderate, or high levels. The ordinal multinomial logistic regression model was used to estimate the relationship among demographic, medical, and psychosocial characteristics. Results: The overall prevalence of low, moderate, and high PA was 20%, 70%, and 10%, respectively. For the domain-specific PA patterns, most par ticipants took par t in leisure-time PA(84.5%);walking was the most common PA. Increased motivation and selfefficacy, lower monthly income, and unemployment were predictors of high PA. Conclusions: PA levels in post-PCI patients was not optimal, and leisure-time PA had the highest par ticipation rate. Analyses of influencing factors can provide medical staff and health workers information to focus on high-risk groups and introduce more tailored interventions. Future studies can explore more regions, and ecological models can be introduced to study more influencing factors.
基金supported by the National Natural Science Foundation of China(No.81870356&No.82170275)the Shanghai Rising-Star Program(20QA1409000).
文摘With advances in the field of interventional cardiology,percutaneous coronary intervention(PCI)has become one of the main treatment methods for patients with coronary artery disease in clinical practice.^([1])Routine interventional therapy is performed under fluoroscopic guidance,and interventional cardiologists are therefore often exposed to radiation.As a result,the risks of cancer,cataract,hair loss and loss of skin pigmentation will be significantly incre-ased after long-term radiation exposure.
基金Key Research and Development Program of the Ministry of Science and Technology(No.2018YFC1704304)。
文摘Objective:To evaluate the impact of hyperuricemia on the occurrence of contrast agentrelated acute kidney injury after percutaneous coronary intervention.Methods:Retrieve PubMed,Embase,Cochrane Library,Web of Science,CNKI,Wanfang,and VIP databases,and publish articles on the correlation between hyperuricemia and contrast agent-related acute kidney damage after percutaneous coronary intervention from the establishment of the database to August 162023.Two researchers independently conducted literature screening and data extraction to evaluate the bias risk of inclusion in the study,and conducted metaanalysis using Review Manager 5.4 software.Results:A total of 12 articles were included,including 11676 patients.The meta-analysis results showed that compared with patients without hyperuricemia,patients with hyperuricemia had a higher risk of developing PC-AKI,with an incidence rate of 22.3%.Hyperuricemia was a risk factor for the occurrence of PCAKI(OR=2.03,95%CI:1.58-2.61);Patients with hyperuricemia have a higher risk of death after PC-AKI,with a mortality rate of 7.5%.Hyperuricemia is a risk factor for early death in PC-AKI patients(OR=2.33,95%CI:1.81-3.00);The probability of CRRT treatment after PCAKI in patients with hyperuricemia is higher,at 3.14%.Hyperuricemia is an influencing factor for CRRT treatment in PC-AKI patients(OR=7,95%CI:2.83-17.30).Conclusion:Existing research evidence suggests that the presence of hyperuricemia is an independent risk factor for the occurrence of PC-AKI,and it significantly increases the hospital mortality rate and the risk of renal replacement therapy in PC-AKI patients.
文摘Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.
文摘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.
文摘Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
基金supported by the National Key Research and Development program of China(2018ZX09201013)Xinxin Merck Cardiovascular Research Fund(2017-CCA-xinxin merck fund-003)。
文摘Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.
文摘BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interval(CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours(OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg(OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI(OR= 1.949, 95%CI 1.168–3.253, P=0.011), low(≤1) TIMI fl ow grade before primary PCI(OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden(OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion(OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-refl ow.CONCLUSION: The occurrence of no-refl ow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.
基金supported by the grants from the National Natural Science Foundation of China(No.81470387)Hubei Province’s Outstanding Medical Academic Leader Program,China
文摘We performed a meta-analysis of randomized controlled trials(RCTs) to investigate the efficacy and safety of ticagrelor(TIC) vs. clopidogrel(CLO) in patients undergoing percutaneous coronary intervention(PCI). In Jun 2016, a literature search was started and all the studies were conducted from 2010 to 2015. We systematically searched the literature through the MEDLINE database, Cochrane library, and EMBASE database. Quality assessments were evaluated with Jadad quality scale. Data were extracted considering the characteristics of efficacy and safety designs. Six RCTs enrolling 26 244 participants and satisfying the inclusion criteria were finally analyzed. There was a significant decrease of all-cause mortality(MD=0.83, 95%CI=0.74–0.93, P=0.001) and myocardial infarction(MI)(MD=0.78, 95%CI=0.70–0.88, P=0.000). There were no significant differences in stroke(MD=1.34, 95%CI=0.99–1.79, P=0.06), total bleeding(MD=0.97, 95%CI=0.84–1.12, P=0.66), minor or major bleeding(MD=1.06, 95%CI=0.94–1.19, P=0.35) in patients undergoing PCI after treatment with TIC vs. CLO. TIC could be more significant in decreasing all-cause mortality and MI than CLO, but there were no significant differences between TIC and CLO in inhibiting stroke, major bleeding, major or minor bleeding in patients undergoing PCI.
基金funded by Research of Korea Centers for Disease Control and Prevention and the Korea Health Technology R & D Project (2016-ER6304-01)Ministry of Health & Welfare (HI13C1527)。
文摘Background There are numerous but conflicting data regarding gender differences in outcomes following percutaneous coronary intervention(PCI). Furthermore, gender differences in clinical outcomes with acute myocardial infarction(AMI) following PCI in Asian population remain uncertain because of the under-representation of Asian in previous trials. Methods A total of 13,104 AMI patients from Korea Acute Myocardial Infarction Registry-National Institute of Health(KAMIR-NIH) between November 2011 and December 2015 were classified into male(n = 8021, 75.9%) and female(n = 2547, 24.1%). We compared the demographic, clinical and angiographic characteristics, 30-days and 1-year major adverse cardiac and cerebrovascular events(MACCE) in women with those in men after AMI by using propensity score(PS) matching. Results Compared with men, women were older, had more comorbidities and more often presented with non-ST segment elevation myocardial infarction(NSTEMI) and reduced left ventricular systolic function. Over the median follow-up of 363 days, gender differences in both 30-days and 1-year MACCE as well as thrombolysis in myocardial infarction minor bleeding risk were not observed in the PS matched population(30-days MACCE: 5.3% vs. 4.7%, log-rank P = 0.494, HR = 1.126, 95% CI: 0.800-1.585;1-year MACCE: 9.3% vs. 9.0%, log-rank P = 0.803, HR = 1.032, 95% CI: 0.802-1.328;TIMI minor bleeding: 4.9% vs. 3.9%, log-rank P = 0.215, HR = 1.255, 95% CI: 0.869-1.814). Conclusions Among Korean AMI population undergoing contemporary PCI, women, as compared with men, had different clinical and angiographic characteristics but showed similar 30-days and 1-year clinical outcomes. The risk of bleeding after PCI was comparable between men and women during one-year follow up.
基金2020 Gansu Planning Projects on Science and Technology,No.20JR10RA352.
文摘BACKGROUND No reflow or slow flow frequently occurs during percutaneous coronary intervention(PCI)and it is associated with adverse outcomes.Strategies should be undertaken to prevent its occurrence.AIM To observe whether conventional target intracoronary administration of sodium nitroprusside immediately before balloon inflation can reduce the incidence of no reflow and slow flow,which are defined as thrombolysis in myocardial infarction flow grade≤II during PCI.METHODS A retrospective study was conducted in 740 patients with coronary artery disease admitted to Gansu Provincial Hospital of Traditional Chinese Medicine between January 2016 and October 2020.Among them,360 patients receiving sodium nitroprusside immediately before balloon inflation during PCI were enrolled in an experimental group between January 2019 and October 2020 and 380 patients receiving sodium nitroprusside after incident no reflow and slow flow during PCI were enrolled in a control group between January 2016 and January 2019.The occurrence of no reflow and slow flow was compared between the two groups and left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were detected 1 mo after the operation.RESULTS After treatment,the proportion of patients with thrombolysis in myocardial infarction flow grades 0 to II was lower in the experimental group than in the control group(P<0.05).At 1 mo after treatment,LVEDD was lower and LVEF was higher in the experimental group than in the control group(P<0.05).In terms of incidence of adverse cardiovascular events within 1 mo after treatment,in the experimental group,malignant arrhythmia occurred in three patients,intractable myocardial ischemia in three,congestive heart failure in four,and recurrent myocardial infarction in five;one patient died.In the control group,malignant arrhythmia occurred in eight patients,intractable myocardial ischemia in five,congestive heart failure in seven,and recurrent myocardial infarction in 14;two patients died.The incidence of adverse cardiovascular events was 4.4%in experimental group which was lower than that of the control group at 1 mo after operation(9.5%;P<0.05).CONCLUSION Administration of sodium nitroprusside into target vessels immediately before balloon inflation can significantly reduce the incidence of no reflow and slow flow,improve LVEDD and LVEF,and reduce the incidence of adverse cardiovascular events in patients treated by PCI.It is worthy of clinical promotion.
文摘AIM To investigate the rates and determinants of success of repeat percutaneous coronary intervention(PCI) following an initial failed attempt at recanalising the chronic total occlusions(CTO) percutaneously.METHODS In 445 consecutive first attempt CTO-PCI procedures in our institution,procedural failure occurred in 149(33.5%). Sixty-four re-PCI procedures were performed in 58 patients(39%) all had a single CTO. Procedural and outcome data in the re-PCI population was entered into the institutional database. A retrospective analysis of clinical,angiographic and procedural data was performed. RESULTS Procedural success was achieved in 41(64%) procedures. Univariate analysis of clinical and angiographic characteristics showed that re-PCI success was associated with intravascular ultrasound(IVUS) guidance(19.5% vs 0%,P = 0.042),while failure was associated with severecalcification(30.4% vs 9.7%,P = 0.047) and a JCTO score > 3(56.5% vs 17.1% P = 0.003). Following multiple regression analysis the degree of lesion complexity(J-CTO score > 3),IVUS use,involvement of an experienced CTO operator and LAD CTO location were significant predictors of successful re-PCI. Overall the complication rate was low,with the only MACCE two periprocedural MI's neither of which required intervention. CONCLUSION Re-PCI substantially increases the overall success rate of CTO revascularization. Predictors of re-PCI success included the use of IVUS,the involvement of an experienced CTO operator in the repeat attempt and the location of the CTO.
基金This work was supported by the National Natural Science Foundation of China(GrantNos.81170279,81370408,81370409)the Social Development Projects of Jiangsu Province(WS074,LJ201116,Q201308)the Projects from Social Development of Zhenjiang(SS2012002,SH2013023,SH2013024).
文摘Purpose:To compare the effectiveness of the interventional limb raising management strategy(ILRMS)to elastic bandage compression at radial vascular access sites following coronary angiographies(CAGs)and percutaneous coronary interventions(PCIs).Methods:Patients with ischemic coronary heart disease whose condition was stable over three months were enrolled in this clinical study(n=590;aged 25e80).All participants had just undergone CAG and PCI.Patients were randomized into either the ILRMS group(n=360)or standard post-intervention care with an elastic bandage(n=230).Overall comfort and wrist pain was assessed and the degree of index finger swelling and oxygen saturation was measured on the affected arm.All variables were measured prior to postintervention treatment and again at six hours after CAG and PCI.Results:We found that patients receiving ILRMS had significantly lower wrist pain scores and swelling around the index finger compared to the elastic bandage group(p<0.05).Oxygen saturation of the index finger was not statistically significant(p>0.05).We also found that 19.57%of the elastic bandage patients were comfortable,while ILRMS patients were significantly more comfortable(93.06%;p<0.05).Conclusions:We find that ILRMS alleviates swelling and pain of the wrist more effectively than current practices and improves the degree of overall comfort of patients who undergo CAG and PCI.
基金National Natural Science Foundation of China No. 81770365National Key Research and Development Program of China No. 2016YFC1301301Beijing United Heart Foundation No. BJUHFCSOARF201901-19。
文摘Objective To analyze factors associated with unplanned revascularization(UR) risk in patients with coronary artery disease(CAD) who underwent percutaneous coronary intervention(PCI).Methods A total of 10,640 cases with CAD who underwent PCI were analyzed. Multivariate COX regressions and competing risk regressions were applied.Results The patients who underwent UR following PCI in 30 days, 1, and 2 years accounted for 0.3%,6.5%, and 8.7%, respectively. After multivariate adjustment, the number of target lesions [hazard ratio(HR) = 2.320;95% confidence interval(CI): 1.643–3.277;P < 0.001], time of procedure(HR = 1.006;95%CI: 1.001–1.010;P = 0.014), body mass index(HR = 1.104;95% CI: 1.006–1.210;P = 0.036), incomplete revascularization(ICR)(HR = 2.476;95% CI: 1.030–5.952;P = 0.043), and age(HR = 1.037;95% CI:1.000–1.075;P = 0.048) were determined as independent risk factors of 30-day UR. Factors, including low-molecular-weight heparin or fondaparinux(HR = 0.618;95% CI: 0.531–0.719;P < 0.001), secondgeneration durable polymer drug-eluting stent(HR = 0.713;95% CI: 0.624–0.814;P < 0.001), left anterior descending artery involvement(HR = 0.654;95% CI: 0.530–0.807;P < 0.001), and age(HR = 0.992;95%CI: 0.985–0.998;P = 0.014), were independently associated with decreased two-year UR risk. While,Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score(HR =1.024;95% CI: 1.014–1.033;P < 0.001) and ICR(HR = 1.549;95% CI: 1.290–1.860;P < 0.001) were negatively associated with two-year UR risk.Conclusion Specific factors were positively or negatively associated with short-and medium-long-term UR following PCI.
基金supported by grant from the National Natural Science Foundation of China[81470486]
文摘Objective The alpha 2A‐adrenergic receptor gene(ADRA2A) polymorphism in individuals modifies the antiplatelet response to sympathetic stimulation. The aim of this study was to investigate the effect of ADRA2A variants on platelet reactivity in Chinese patients on dual antiplatelet therapy(DAPT) after undergoing percutaneous coronary intervention(PCI).Methods From March 2011 to March 2013, 1,024 patients were enrolled in this prospective,single‐center, observational study in China. Four single nucleotide polymorphisms(SNPs) of ADRA2A gene(rs11195419, rs3750625, rs13306146, and rs553668) and CYP2 C19*2 were detected by ligase detection reaction(LDR), and adenosine diphosphate(ADP) inhibition was detected by thromboelastography(TEG~?).Results The minor allele frequencies of ADRA2A SNPs were common. Platelet ADP inhibition was significantly different among patients carrying rs11195419(adjusted P = 0.022) and rs3750625(adjusted P = 0.016). The homozygous allele carriers had the lowest ADP inhibition. However, ADP inhibition was not significantly different in rs553668 and rs13306146. At the multivariate analysis, rs11195419(P =0.033), rs3750625(P = 0.020) and CYP2 C19*2(P = 0.002) were independent predictors of ADP inhibition. Subgroups analysis based on sex showed rs11195419(P = 0.003) and rs3750625(P = 0.002)were significantly associated with ADP inhibition in males, but not in females.Conclusion ADRA2A genetic variations were associated with ADP‐induced platelet aggregation during DAPT in Chinese patients undergoing PCI, and the effect was particularly more pronounced in males.
基金The report was supported by grants from the Beijing Nova Program(No.Z121107002512053)the Beijing Health System High Level Health Technology Talent Cultivation Plan(No.2013-3-013)+3 种基金Beijing Outstanding Talent Training Program(No.2014000021223ZK32)the National Natural Science Foundation of China(No.81100143)the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(No.ZYLX 201303)and the National Key Clinical Speciality Construction Project.
文摘Objective To evaluate the effects and mechanisms of glucose-insulin-potassium(GIK)on post-procedural myocardial injury(PMI)after percutaneous coronary intervention(PCI).Methods A total of 200 non-diabetic patients with documented coronary heart disease(CHD)were divided into the Group GIK and Group G,with 100 patients in each group.Patients in Group G were given intravenous infusion of glucose solution 2 hours before PCI.As compared,patients in Group GIK were given GIK.Results Both post-procedural creatine phosphokinase isoenzyme MB(CK-MB;62.1±47.8 vs.48.8±52.6 U/L,P=0.007)and cTnI(0.68±0.83 vs.0.19±0.24 ng/mL,P<0.001)in Group GIK were significantly higher than those in Group G.In Group G,9.0%and 4.0%of patients had post-procedural increases in CK-MB 1-3 times and>3 times,which were significantly lower than those in Group GIK(14.0%and 7.0%,respectively;all P values<0.01);13.0%and 7.0%of patients had post-procedural increases in cTnI 1-3 times and>3 times,which were also significantly lower than those in Group GIK(21.0%and 13.0%,respectively;all P<0.001).Pre-procedural(10.2±4.5 vs.5.1±6.3,P<0.001)and post-procedural rapid blood glucose(RBG)levels(8.9±3.9 vs.5.3±5.6,P<0.001)in Group G were higher than those in Group GIK.In adjusted logistic models,usage of GIK(compared with glucose solution)remained significantly and independently associated with higher risk of post-procedural increases in both CK-MB and cTnI levels>3 times.Furthermore,pre-procedural RBG levels<5.0mmol/L were significantly associated with higher risk of post-procedural increases in both CK-MB and cTnI levels.Conclusions In non-diabetic patients with CHD,the administration of GIK may increase the risk of PMI due to hypoglycemia induced by GIK.
基金Supported by Scientific Research Program of Hebei Administration of Traditional Chinese Medicine,China,No.2021201Science and Technology Support Plan Project of Chengde,China,No.201701A072.
文摘BACKGROUND Vascular complications of transradial percutaneous coronary intervention(PCI)are rare and usually occur at the access site below the elbow.Life-threatening vascular complications during transradial PCI therapy,such as vessel perforation and dissection in the brachiocephalic,subclavian,internal mammary,and thyrocervical arteries,are rarely reported.Subclavian artery bleeding is a potentially serious complication of vascular interventional procedures leading to tracheal obstruction,hemothorax,respiratory failure,hemorrhagic shock,and death if not diagnosed early and treated promptly.CASE SUMMARY A male patient with typical angina pectoris underwent coronary angiography and stent implantation.During the procedure,the patient felt pharyngeal pain and tightness,which we mistook for myocardial ischemia.After PCI,swelling in the right neck and supraclavicular area was observed.The patient experienced dyspnea,emergency endotracheal intubation was performed,and then a sudden drop in blood pressure was observed.Ultrasound and contrast-enhanced computed tomography scans demonstrated a cervical hematoma severely compressing the trachea due to subclavian artery bleeding.Brachiocephalic angiography revealed a vascular injury site at the root of the right subclavian artery at the intersection of the right common carotid artery.A covered stent was deployed to the right subclavian artery with successful sealing of the perforation,and a bare stent was implanted in the junction of the right common carotid and brachiocephalic arteries to prevent obstruction of blood flow to the brain.CONCLUSION Subclavian artery bleeding is a lifethreatening complication of PCI.Early prevention,rapid recognition,and prompt treatment may improve the prognosis.
