目的观察急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者,术中出现无复流及慢血流时,予大剂量替罗非班冠状动脉内注射处理的疗效。方法选取96例STEMI行急诊PCI治疗的患者,术前给予阿托伐他汀、阿司匹林、氯吡格雷...目的观察急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者,术中出现无复流及慢血流时,予大剂量替罗非班冠状动脉内注射处理的疗效。方法选取96例STEMI行急诊PCI治疗的患者,术前给予阿托伐他汀、阿司匹林、氯吡格雷负荷量处理,术中出现无血流或慢血流现象时,予以实验组大剂量替罗非班(25μg·kg-1)冠状动脉内推注,对照组予以常规剂量(10μg·kg-1)处理,待血流恢复后植入药物洗脱支架。患者经上述处理后,以术后冠脉血流TIMI分级、术后24 h ST段完全回落率、术后1周血清肌钙蛋白I完全正常率、术后1月的左心室射血分数、术后1个月的主要心血管事件(死亡、心力衰竭、再发心肌梗死、恶性心律失常、反复心绞痛发作等)作为评价指标。结果患者年龄、性别、家族史、吸烟史、饮酒史、高血压病史、脑梗死病史、高脂血症、糖尿病病史、心功能Killip分级、心肌梗死部位、植入支架数量等差异无统计学意义,不具有可比性。但患者术中冠脉血流TIMI 3级获得率大剂量组(85.42%)较对照组(52.08%)高,差异有统计学意义;术后24 h ST段完全回落率,大剂量组(83.33%)高于对照组(56.25%),差异有统计学意义;术前患者左心室射血分数差异无统计学意义,但术后1个月的左心室射血分数,大剂量组优于实验组。术后1个月随访,两组在主要心血管事件的发生率上差异有统计学意义。结论对于STEMI患者,急诊PCI术中出现无复流及慢血流时,予以大剂量替罗非班冠状动脉内注射处理,可显著改善上述表现,且并未增加出血事件的发生率,可提高临床预后。展开更多
背景:脂蛋白a(Lp(a))是急性心肌梗死(AMI)患者发生不良心血管事件的独立危险因素,与AMI后心脏重构密切相关。目的:本研究旨在探讨Lp(a)与急性前壁ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心室重构的关系以及对心肌梗死...背景:脂蛋白a(Lp(a))是急性心肌梗死(AMI)患者发生不良心血管事件的独立危险因素,与AMI后心脏重构密切相关。目的:本研究旨在探讨Lp(a)与急性前壁ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心室重构的关系以及对心肌梗死后心室重构的预测价值。方法:纳入本院行冠状动脉介入治疗的前壁STEMI患者218例,在心肌梗死后1周和6个月通过心脏超声评估左心室功能和体积。不良心室重构(VR)的定义是基于心肌梗死后6个月左室舒张末期容积增加≥20%。根据患者左心室重构情况分为心室重构组和非心室重构组。比较两组患者的Lp(a)及临床资料,采用多因素Logistic回归法分析影响前壁STEMI患者PCI术后左心室重构的相关因素;将独立危险因素创建受试者工作特征曲线(ROC),分析Lp(a)对心肌梗死后心室重构的预测价值。结果:6个月后,218例前壁STEMI患者中,58例患者出现心室重构。根据患者左心室重构情况分为心室重构组(160例)和非心室重构组(58例)。与非心室重构组比较,心室重构组年龄、糖尿病史、糖化血红蛋白、肌钙蛋白I、肌酸激酶同工酶、C反应蛋白、NT-proBNP、低密度脂蛋白胆固醇、Lp(a)、Gensini评分、室壁运动记分指数(WMSI)均显著升高,左心室射血分数(LVEF)显著下降,差异具有统计学意义;心室重构组LVEF显著降低,差异具有统计学意义;二元Logistic回归分析显示肌钙蛋白I、C反应蛋白、Lp(a)、LVEF是前壁STEMI患者PCI手术心室重构的独立危险因素。高Lp(a)是VR的独立预测因子(OR = 1.006, P Background: Lipoprotein a (Lp(a)) is an independent risk factor for adverse cardiovascular events in patients with acute myocardial infarction (AMI) and is closely related to cardiac remodeling after AMI. Objective: The purpose of this study was to investigate the relationship between Lp(a) and ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute anterior ST-elevation myocardial infarction (STEMI) and its predictive value after myocardial infarction. Methods: A total of 218 patients with anterior STEMI undergoing coronary intervention in our hospital were enrolled in our hospital, and left ventricular function and volume were evaluated by cardiac ultrasound at 1 week and 6 months after myocardial infarction. Poor ventricular remodeling (VR) is defined as a ≥ 20% increase in left ventricular end-diastolic volume 6 months after myocardial infarction. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group and non-ventricular remodeling group. The Lp(a) and clinical data of the two groups were compared, and the multivariate logistic regression method was used to analyze the relevant factors affecting left ventricular remodeling after PCI in patients with anterior STEMI. The receiver operating characteristic curve (ROC) was created for independent risk factors, and the predictive value of Lp(a) in ventricular remodeling after myocardial infarction was analyzed. Results: After 6 months, ventricular remodeling occurred in 58 of the 218 patients with anterior STEMI. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group (160 cases) and non-ventricular remodeling group (58 cases). Compared with the non-ventricular remodeling group, the age, diabetes history, glycosylated hemoglobin, troponin I, creatine kinase isoenzyme, C-reactive protein, NT-proBNP, low-density lipoprotein cholesterol, Lp(a), Gensini score, and wall motion scoring index (WMSI) in the ventricular remodeling group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased, and the difference was statistically significant. LVEF was significantly reduced in the ventricular remodeling group, and the difference was statistically significant. Binary logistic regression analysis showed that troponin I, C-reactive protein, Lp(a) and LVEF were independent risk factors for ventricular remodeling after PCI in patients with anterior STEMI. High Lp(a) was an independent predictor of VR (OR = 1.006, P < 0.001). The optimal cut-off value of Lp(a) for predicting VR was 342, with a sensitivity of 82.6% and a specificity of 81.6% (AUC = 0.842, P < 0.001). Conclusion: Lp(a) is associated with left ventricular remodeling after percutaneous coronary intervention (PCI) in patients with anterior STEMI, and Lp(a) is a useful tool for predicting the risk of ventricular remodeling after myocardial infarction, and early clinical intervention is recommended.展开更多
目的观察行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者予以联合应用血栓抽吸和大剂量替罗非班的临床疗效及预后。方法 78例STEMI患者随机分为试验组(30例)与对照组(48例),术中试验组序贯给予血栓抽吸和大剂量...目的观察行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者予以联合应用血栓抽吸和大剂量替罗非班的临床疗效及预后。方法 78例STEMI患者随机分为试验组(30例)与对照组(48例),术中试验组序贯给予血栓抽吸和大剂量替罗非班冠状动脉内推注处理,对照组仅予以大剂量替罗非班冠状动脉内推注处理,经处理后植入支架。观察术后冠状动脉血流TIMI分级、24 h ST段完全回落率、第7天的左心室射血分数(LVEF)、1个月的主要心血管事件(MACE)。结果两组患者年龄、性别、吸烟史、饮酒史、高血压病史、术前LVEF差异均无统计学意义(P>0.05);试验组术后血流TIMI 3级获得率、24 h ST段完全回落率及第7天LVEF的结果均高于对照组,差异有统计学意义(P<0.05),术后1个月MACE的发生率无统计学差异(P>0.05)。结论 STEMI患者急诊PCI术中予以联合应用血栓抽吸术及大剂量替罗非班,可显著增加心肌供血,改善心功能及愈后。展开更多
文摘目的观察急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者,术中出现无复流及慢血流时,予大剂量替罗非班冠状动脉内注射处理的疗效。方法选取96例STEMI行急诊PCI治疗的患者,术前给予阿托伐他汀、阿司匹林、氯吡格雷负荷量处理,术中出现无血流或慢血流现象时,予以实验组大剂量替罗非班(25μg·kg-1)冠状动脉内推注,对照组予以常规剂量(10μg·kg-1)处理,待血流恢复后植入药物洗脱支架。患者经上述处理后,以术后冠脉血流TIMI分级、术后24 h ST段完全回落率、术后1周血清肌钙蛋白I完全正常率、术后1月的左心室射血分数、术后1个月的主要心血管事件(死亡、心力衰竭、再发心肌梗死、恶性心律失常、反复心绞痛发作等)作为评价指标。结果患者年龄、性别、家族史、吸烟史、饮酒史、高血压病史、脑梗死病史、高脂血症、糖尿病病史、心功能Killip分级、心肌梗死部位、植入支架数量等差异无统计学意义,不具有可比性。但患者术中冠脉血流TIMI 3级获得率大剂量组(85.42%)较对照组(52.08%)高,差异有统计学意义;术后24 h ST段完全回落率,大剂量组(83.33%)高于对照组(56.25%),差异有统计学意义;术前患者左心室射血分数差异无统计学意义,但术后1个月的左心室射血分数,大剂量组优于实验组。术后1个月随访,两组在主要心血管事件的发生率上差异有统计学意义。结论对于STEMI患者,急诊PCI术中出现无复流及慢血流时,予以大剂量替罗非班冠状动脉内注射处理,可显著改善上述表现,且并未增加出血事件的发生率,可提高临床预后。
文摘背景:脂蛋白a(Lp(a))是急性心肌梗死(AMI)患者发生不良心血管事件的独立危险因素,与AMI后心脏重构密切相关。目的:本研究旨在探讨Lp(a)与急性前壁ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心室重构的关系以及对心肌梗死后心室重构的预测价值。方法:纳入本院行冠状动脉介入治疗的前壁STEMI患者218例,在心肌梗死后1周和6个月通过心脏超声评估左心室功能和体积。不良心室重构(VR)的定义是基于心肌梗死后6个月左室舒张末期容积增加≥20%。根据患者左心室重构情况分为心室重构组和非心室重构组。比较两组患者的Lp(a)及临床资料,采用多因素Logistic回归法分析影响前壁STEMI患者PCI术后左心室重构的相关因素;将独立危险因素创建受试者工作特征曲线(ROC),分析Lp(a)对心肌梗死后心室重构的预测价值。结果:6个月后,218例前壁STEMI患者中,58例患者出现心室重构。根据患者左心室重构情况分为心室重构组(160例)和非心室重构组(58例)。与非心室重构组比较,心室重构组年龄、糖尿病史、糖化血红蛋白、肌钙蛋白I、肌酸激酶同工酶、C反应蛋白、NT-proBNP、低密度脂蛋白胆固醇、Lp(a)、Gensini评分、室壁运动记分指数(WMSI)均显著升高,左心室射血分数(LVEF)显著下降,差异具有统计学意义;心室重构组LVEF显著降低,差异具有统计学意义;二元Logistic回归分析显示肌钙蛋白I、C反应蛋白、Lp(a)、LVEF是前壁STEMI患者PCI手术心室重构的独立危险因素。高Lp(a)是VR的独立预测因子(OR = 1.006, P Background: Lipoprotein a (Lp(a)) is an independent risk factor for adverse cardiovascular events in patients with acute myocardial infarction (AMI) and is closely related to cardiac remodeling after AMI. Objective: The purpose of this study was to investigate the relationship between Lp(a) and ventricular remodeling after percutaneous coronary intervention (PCI) in patients with acute anterior ST-elevation myocardial infarction (STEMI) and its predictive value after myocardial infarction. Methods: A total of 218 patients with anterior STEMI undergoing coronary intervention in our hospital were enrolled in our hospital, and left ventricular function and volume were evaluated by cardiac ultrasound at 1 week and 6 months after myocardial infarction. Poor ventricular remodeling (VR) is defined as a ≥ 20% increase in left ventricular end-diastolic volume 6 months after myocardial infarction. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group and non-ventricular remodeling group. The Lp(a) and clinical data of the two groups were compared, and the multivariate logistic regression method was used to analyze the relevant factors affecting left ventricular remodeling after PCI in patients with anterior STEMI. The receiver operating characteristic curve (ROC) was created for independent risk factors, and the predictive value of Lp(a) in ventricular remodeling after myocardial infarction was analyzed. Results: After 6 months, ventricular remodeling occurred in 58 of the 218 patients with anterior STEMI. According to the left ventricular remodeling, the patients were divided into ventricular remodeling group (160 cases) and non-ventricular remodeling group (58 cases). Compared with the non-ventricular remodeling group, the age, diabetes history, glycosylated hemoglobin, troponin I, creatine kinase isoenzyme, C-reactive protein, NT-proBNP, low-density lipoprotein cholesterol, Lp(a), Gensini score, and wall motion scoring index (WMSI) in the ventricular remodeling group were significantly increased, and the left ventricular ejection fraction (LVEF) was significantly decreased, and the difference was statistically significant. LVEF was significantly reduced in the ventricular remodeling group, and the difference was statistically significant. Binary logistic regression analysis showed that troponin I, C-reactive protein, Lp(a) and LVEF were independent risk factors for ventricular remodeling after PCI in patients with anterior STEMI. High Lp(a) was an independent predictor of VR (OR = 1.006, P < 0.001). The optimal cut-off value of Lp(a) for predicting VR was 342, with a sensitivity of 82.6% and a specificity of 81.6% (AUC = 0.842, P < 0.001). Conclusion: Lp(a) is associated with left ventricular remodeling after percutaneous coronary intervention (PCI) in patients with anterior STEMI, and Lp(a) is a useful tool for predicting the risk of ventricular remodeling after myocardial infarction, and early clinical intervention is recommended.
文摘目的观察行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者予以联合应用血栓抽吸和大剂量替罗非班的临床疗效及预后。方法 78例STEMI患者随机分为试验组(30例)与对照组(48例),术中试验组序贯给予血栓抽吸和大剂量替罗非班冠状动脉内推注处理,对照组仅予以大剂量替罗非班冠状动脉内推注处理,经处理后植入支架。观察术后冠状动脉血流TIMI分级、24 h ST段完全回落率、第7天的左心室射血分数(LVEF)、1个月的主要心血管事件(MACE)。结果两组患者年龄、性别、吸烟史、饮酒史、高血压病史、术前LVEF差异均无统计学意义(P>0.05);试验组术后血流TIMI 3级获得率、24 h ST段完全回落率及第7天LVEF的结果均高于对照组,差异有统计学意义(P<0.05),术后1个月MACE的发生率无统计学差异(P>0.05)。结论 STEMI患者急诊PCI术中予以联合应用血栓抽吸术及大剂量替罗非班,可显著增加心肌供血,改善心功能及愈后。
