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Management of non ST segment elevation acute coronary syndromes： A shift in the paradigm

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Chinese Medical Journal 2008年第1期000卷 3-5页

作者： jean-pierre bassand Professor of Cardiology Head of Cardiology DepartmentUniversity Hospital Jean Minjoz Boulevard Fleming 25000Besancon France (Bassand JP)

The new European guidelines on the management of non-ST segment elevation acute coronary syndromes （NSTE-ACS） were published in June 2007, two months before the American College of Cardiology-American Heart Association （ACC-AHA） guideline update on the same topic.^1.2 The European Society of Cardiology （ESC） guidelines differ from the American guidelines on a certain number of points： the ESC document is much shorter,

关键词：冠状动脉疾病急性病心电描记术综合征人类

Predictors of long-term clinical outcome of patients with acute massive pulmonary embolism after thrombolytic therapy

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Chinese Medical Journal 2003年第4期116卷 503-509页

作者：刘品明 Nicolas Meneveau Francois Schiele jean pierre bassand Department of Cardiology Second Affiliated HospitalZhongshan University Service de Cardiologie Centre Hospitalier Universitare

To assess the in-hospital clinical course and the long-term evolution of acute massive pulmonary embolism after thrombolytic therapy and to identify predictors of adverse clinical outcome Methods A total of 260 patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3 9 to 8 4 years Baseline characteristics and variables pre- and post-thrombolysis were identified Particular attention was paid to the clinical events, including death, recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, and major bleeding attributable to the use of anticoagulants Kaplan-Meier event-free survival curves were generated Univariate analysis by means of the log-rank test was used to test each candidate variable for association with clinical outcome Multivariate analysis with the Cox proportional hazard model was used to determine independent predictors of the long-term outcome Results The in-hospital mortality rate was 8 5%, with 68 2% due to pulmonary embolism itself, and the follow-up mortality rate was 31 7%, with 29 2% due to recurrent embolism Factors associated with an adverse outcome in univariate analysis were: (1) prior thromboembolic diseases; (2) duration of anticoagulant therapy 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by pulmonary ventilation/perfusion scintigraphy before hospital discharge Multivariate analysis identified three independent predictors of poor long-term outcome for patients with acute massive pulmonary embolism after thrombolysis; which were: (1) Doppler recording of pulmonary artery systolic pressure >50 mm Hg, with relative risk of 3 78 and a 95% confidence interval of 2 70 to 4 86; (2)

关键词： pulmonary embolism · deep venous thrombosis · thrombolytic therapy

急性肺血栓栓塞症患者溶栓治疗后的远期预后分析

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中华内科杂志 2002年第11期41卷 750-753页

作者：刘品明 Nicolas Meneveau Franois Schiele jean-pierre bassand 中山大学附属第二医院心内科广州510120 Department of Cardiology Franche Comt university hospital Jean Minjoz

目的　分析急性大面积肺血栓栓塞症 (PTE)患者溶栓治疗后的远期预后。方法　对2 60例急性PTE患者进行溶栓治疗并随访 ,分析其临床资料及引起远期临床事件 [死亡、再发深静脉血栓形成、再发PTE、慢性血栓栓塞性肺动脉高压和 (或 )右心衰... 详细信息

目的　分析急性大面积肺血栓栓塞症 (PTE)患者溶栓治疗后的远期预后。方法　对2 60例急性PTE患者进行溶栓治疗并随访 ,分析其临床资料及引起远期临床事件 [死亡、再发深静脉血栓形成、再发PTE、慢性血栓栓塞性肺动脉高压和 (或 )右心衰竭、抗凝治疗出现大出血、依赖家庭氧疗 ]的危险因素。结果　 2 60例PTE患者在住院期间死亡 2 2例 (8 5 % ) ,其中 1 5例 (62 8% )死于PTE。随访 2 2 7例患者 ,为期 3 9～ 8 4年 ,死亡 72例 (31 7% ) ,其中有 2 1例患者死于再发PTE。对随访资料完整的 1 65例患者进行远期临床事件的危险因素分析 ,单因素分析显示 ,既往有血栓栓塞病史、抗凝治疗不足 6个月、植入下腔静脉滤器、溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %与远期临床事件的发生相关 ;多变量分析显示 ,溶栓后超声心动图仍显示右室功能障碍和 (或 )扩大、溶栓后超声多普勒仍测得肺动脉收缩压 >50mmHg、出院前核素肺通气 /灌注扫描显示肺血管床阻塞 >30 %是PTE远期预后的独立危险因素。结论　通过高危因素的确立 ,可予患者更积极的治疗。

关键词：急性肺血栓栓塞症溶栓治疗预后危险因素

Early local intracoronary platelet activation after drug-eluting stent placement

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Chinese Medical Journal 2007年第22期120卷 1986-1991页

作者： Ailiman Mahemuti Nicolas Meneveau Marie-France Seronde FrancoisSchiele Mariette Mercier Evelyne Racadotand jean-pierre bassand Department of Cardiology First Affiliated Hospital of Xinjiang Medical UniversityUrumqi 830054Xinjiang Uygur Autonomous RegionChina Department of Biostatistics and Epidemiology Faculty of Medecine and PharmacyUniversity of Franche-Comte Medical SchoolBesanconFrance Hemostasis Laboratory French Blood Products InstitutionBesanconFrance

Background Early local platelet activation after coronary intervention identifies patients at increased risk of acute stent thrombosis （AST）. However, early changes in platelet activation in coronary circulation following drug-eluting stent （DES） implantation have never been reported. Methods In a prospective study of 26 consecutive elective stable angina patients, platelet activation was analyzed by measuring soluble glycoprotein V （sGPV） and P-selectin （CD62P） before and after implantation of either DES or bare metal stent （BMS）. All patients were pretreated with clopidogrel （300 mg loading dose） and aspirin （75 mg orally） the day before the procedure. Blood samples were drawn from the coronary ostium and 10 - 20 mm distal to the lesion site. Results Consistent with the lower baseline clinical risk, the levels of CD62P and sGPV were within normal reference range, both in the coronary ostium and distal to the lesion before percutaneous coronary intervention （PCI） procedure. The levels of CD62P and sGPV did not change significantly （CD62P：（31.1 ± 9.86） ng/ml vs （29.5 ± 9.02） ng/ml, P=0.319 and sGPV：（52.4 ± 13.5） ng/ml vs （51.8 ± 11.7） ng/ml, P=0.674, respectively） after stent implantation when compared with baseline. Changes in these platelet activation markers did not differ between stent types. Conclusions Intracoronary local platelet activation does not occur in stable angina patients before and immediately followina DES implantation when dual anti-Dlatelet is administered.

关键词： stents platelet activation thrombosis P-selectin soluble glycoprotein V

Value of intravascular ultrasound imaging in following up patients with replacement of the ascending aorta for acute type A aortic dissection

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Chinese Medical Journal 2008年第21期121卷 2139-2143页

作者： HU Wei Francois Schiele Nicolas Meneveau Marie-France Seronde pierre Legalery Fiona Caulfield jean-Frangois Bonneville Sidney Chocron jean-pierre bassand Department of Cardiology Min Hang Central Hospital Shanghai 201100 China Department of Cardiology Jean Minjoz Hospital Besancon 25000 France Department of Radiology Jean Minjoz Hospital Besancon 25000 France Department of Cardiac Surgery Jean Minjoz Hospital Besancon 25000 France

Background The value of intravascular ultrasound （IVUS） imaging in patients with replacement of the ascending aorta for acute type A aortic dissection （AD） is unknown. The purpose of this study was to assess the potential use of IVUS imaging in this setting. Methods From September 2002 to July 2005, IVUS imaging with a 9 MHz probe was performed in a series of 16 consecutive patients with suspected or established AD. This study focused on 5 of them with replacement of the ascending aorta for acute type A AD. Among these 5 patients, other imaging modalities including aortography, spiral computed tomography, magnetic resonance imaging and transesophageal echocardiography were performed in 5, 3, 3 and 1 patients, respectively. Results There were no complications related to IVUS imaging. For the replaced graft, as other imaging modalities, IVUS could identify all 5 grafts, the proximal and the distal anastomoses, and the ostia of the reimplanted coronary arteries. In 2 cases, IVUS detected 2 peri-graft pseudo-aneurysms （1 per case）, which were also detected by magnetic resonance imaging but omitted by aortography. For the residual dissection, IVUS had similar findings as other imaging modalities in detecting the patency （5/5）, the longitudinal and the circumferential extent, the thrombus （4/5）, the recurrent dissection （1/5） and an aneurysm distal to the graft （5 in 4 patients）. However, it detected more intimal tears and side branch involvements than other imaging modalities （15 vs 10 and 3 vs 1, respectively）. Conclusions In following-up patients with replacement of the ascending aorta for acute type A AD, IVUS imaging can provide complete information of the replaced graft and the residual dissection. So, IVUS imaging may be considered when the four current frequently used imaging modalities can not supply sufficient information or there are some discrepancies between them.

关键词： intravascular ultrasound aortic dissection graft

巨细胞病毒感染与冠状动脉支架内新生内膜组织量的关系

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中华心血管病杂志 2003年第11期31卷 826-829页

作者：刘品明张少玲 Franois Schiele Nicolas Meneveau jean-pierre bassand 中山大学附属第二医院内科广州510120 法国Franche-Comté大学jean-Minjoz医院心内科

目的　探讨巨细胞病毒 (CMV)感染对冠状动脉支架内内膜增生的影响。方法　 180例冠心病患者 ,于冠状动脉内支架置入术后 6个月复查冠状动脉造影和血管内超声检查。定量冠状动脉造影测定随访时的腔径减小 ,血管内超声测定支架内的平均新... 详细信息

目的　探讨巨细胞病毒 (CMV)感染对冠状动脉支架内内膜增生的影响。方法　 180例冠心病患者 ,于冠状动脉内支架置入术后 6个月复查冠状动脉造影和血管内超声检查。定量冠状动脉造影测定随访时的腔径减小 ,血管内超声测定支架内的平均新生内膜组织面积及其与支架横截面积之比。酶联免疫吸附法测定抗人CMVIgG抗体。结果　CMV感染率达 5 1%。平均血管参考直径为 (2 94± 0 4 8)mm ,支架置入使平均最小腔内直径由 (0 99± 0 35 )mm上升至 (2 4 5± 0 4 2 )mm。 6个月随访时平均腔径减小 (0 74± 0 5 0 )mm ;平均新生内膜组织面积为 (3 8± 1 7)mm2 ,其与平均支架横截面积之比为 (4 5± 18) %。逐步多变量回归分析显示上述再狭窄指标与CMV感染无关联。结论　既往CMV感染与冠状动脉支架内新生内膜组织量无关。

关键词：巨细胞病毒感染内膜增生冠心病冠状动脉内支架置入术经皮冠状动脉血管成形术

Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

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Chinese Medical Journal 2001年第3期114卷 38-41,105页

作者：张大东蔡煦沈卫峰上海第二医科大学附属瑞金医院心脏科上海200025

Objective To observe the immediate angiographic and intravascular ultrasound (IVUS) results and their effects on one month clinical outcomes in forty one patients who submitted to coronary stent deployment with IVUS guidance Methods All patients were allocated to coronary stent implantation with high inflation pressure After good angiographic results (<20% residual stenosis), all patients underwent IVUS and higher pressure dilatation would be necessary if criteria for optimal coronary stent implantation were not met The optimal criterion of IVUS for stent implantation was the ratio of intrastent lumen cross sectional area to the average of the proximal and distal reference lumen cross sectional areas ≥80% All patients had aspirin and ticlopidine therapy on the day of angioplasty and during the one month follow up period Results Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty five patients but intrastent higher pressure dilatation was performed in fourteen patients whose ultrasound results did not reach the criteria In these patients, we increased the minimal intrastent lumen area 25 7% ( P <0 05) Thirty five patients (90%) had good minimal intrastent lumen area of IVUS There were no deaths, myocardial infarction, acute stent thrombosis or need for revascularization during the study and the one month follow up Conclusions Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical outcomes after one month follow up

关键词： percutaneous transluminal coronary angioplasty · intracoronary stent · intravascualr ultrasound

经皮冠状动脉介入术中止血活性的早期改变及与纤溶酶原激活剂抑制物-1基因多态性的相关性

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介入放射学杂志 2007年第9期16卷 584-588页

作者：艾力曼.马合木提 Nicolas Meneveau Francois Schiele jean-pierre bassand 法国Besancon Franche-comté大学jean-Minjoz大学中心医院心血管中心新疆医科大学第一附属医院心血管中心

目的探讨经皮冠状动脉介入(PCI)术中冠状动脉内血浆纤溶酶原激活剂抑制物-1(PAI-1)、D-二聚体(D-D)、凝血因子Ⅶ(FⅦa)及可溶性P选择素(CD62P)活性在球囊扩张和支架植入前后的早期改变及其与PAI-1基因多态性的相关性,评估其对急性支架... 详细信息

目的探讨经皮冠状动脉介入(PCI)术中冠状动脉内血浆纤溶酶原激活剂抑制物-1(PAI-1)、D-二聚体(D-D)、凝血因子Ⅶ(FⅦa)及可溶性P选择素(CD62P)活性在球囊扩张和支架植入前后的早期改变及其与PAI-1基因多态性的相关性,评估其对急性支架血栓形成的预测价值。方法选择稳定型心绞痛患者20例,按标准方法行冠状动脉造影且证实冠状动脉狭窄均在70%以上。术中冠状动脉内血样采集顺序依次为:球囊扩张前冠状动脉入口处(Ostium)用引导导管,球囊扩张15min以后及支架植入后15min通过血栓吸引器穿过病灶在病变远端采血。结果PAI-1基因多态性在本组中分布为4G/5G型最多(12例,60%),4G/4G型其次(6例,30%),5G/5G型最少(2例,10%)。4G和5G等位基因频率分别为60%和40%。具有PAI-14G/5G基因型患者冠状动脉内血浆PAI-1、D-D以及FⅦ活性在球囊扩张后较球囊扩张前明显升高且有统计学意义(P均为0.01),然而这些指标在球囊扩张前与支架植入后比较无显著性差异。结论球囊扩张较支架植入更易损伤血管内皮并导致冠状动脉内局部、早期止血活性的一过性增高,具有PAI-14G/5G基因型患者对这种反应较为敏感。PCI术前双联抗血小板药物可以有效抑制血小板活性。

关键词：经皮冠状动脉介入术基因,多态性纤溶酶原激活剂抑制-1 凝血因子Ⅶ 可溶性P选择素 D-二聚体

药物涂层支架与金属裸支架对稳定型心绞痛患者局部冠状动脉循环组织因子水平早期影响的比较

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中国介入心脏病学杂志 2008年第3期16卷 155-158页

作者：艾力曼·马合木提 Nicolas Meneveau 刘品明 Francois Schiele jean-pierre bassand 法国Besanon Franche-comté大学大学中心医院心脏中心中山医科大学第二附属医院心内科新疆医科大学第一附属医院心脏中心乌鲁木齐830054

目的比较药物涂层支架(DES)与金属裸支架(BMS)置入前后冠状动脉循环内局部血浆组织因子(TF)水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓(AST)形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证... 详细信息

目的比较药物涂层支架(DES)与金属裸支架(BMS)置入前后冠状动脉循环内局部血浆组织因子(TF)水平的变化,探讨DES对血浆TF水平的早期改变及其对急性支架内血栓(AST)形成的意义。方法入选稳定型心绞痛患者26例,按标准方法行冠状动脉造影证实有冠状动脉狭窄均在70%以上。其中15例置入DES(DES组),11例置入BMS(BMS组)。全部患者术前给予阿司匹林、氯吡格雷口服,支架置入前静脉给予低分子质量肝素。PCI术中冠状动脉内血样采集顺序依次为:支架置入前后冠状动脉入口处(ostium)用引导导管,支架置入后15 min通过血栓吸引器穿过病灶在病灶下方(beyond the lesion)采血。血浆TF水平检测采用酶联免疫双抗体夹心法(ELISA)。结果PCI术前26例患者在冠状动脉入口处与病灶下方冠状动脉循环内的TF基线水平比较差异无统计学意义(31.50±7.05 ng/L比31.40±7.30 ng/L,P=0.748),但高于正常参考值3倍;支架置入后15min在冠状动脉入口处(29.60±6.96 ng/L比31.50±7.05 ng/L,P=0.135)与病灶下方(30.70±7.70 ng/L比31.40±6.30 ng/L,P=0.230)冠状动脉循环内的TF水平与术前比较,差异亦无统计学意义。术后15min,DES组和BMS组冠状动脉入口处(31.20±4.37 ng/L比30.70±5.39 ng/L,P=0.674)及病灶下方(31.60±5.39 ng/L比29.00±7.96 ng/L,P=0.789)TF水平差异均无统计学意义。结论稳定型心绞痛患者冠状动脉循环血内存在大量的TF。DES和BMS两种支架均不引起冠状动脉内局部、早期血浆TF水平的改变。

关键词：血管成形术,经腔,经皮冠状动脉支架冠状动脉血栓形成组织因子