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肿瘤坏死因子-α受体1是急性心肌梗死患者死亡率及新发心衰的主要预测指标:心肌梗死患者的细胞因子激活及远期预后(C-ALPHA)研究

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世界核心医学期刊文摘（心脏病学分册） 2005年第8期1卷 30-31页

作者： valgimigli M. Ceconi C. Malagutti P. 丁倩 Department of Cardiology University of Ferrara Cardiovascular Institute A. S. Anna C.rso Giovecca 203 44100 Ferrara Italy

Background Tumor necrosis factor alpha- α (TNF- α ) activation is an independent prognostic indicator of mortality in patients with heart failure(HF). Despite the recognition that several TNF family cytokines are elevated during myocardial infarction, their role in predicting subsequent prognosis in these setting remains poorly understood. Methods and Results We performed a systematic evaluation of TNF- α and its type 1 and 2 soluble receptors, together with interleukin(IL)- 6, IL- 1 receptor antagonist, and IL- 10, in 184 patients(132 men; mean age, 64± 12) consecutively admitted for myocardial infarction. We correlated their values to short and long- term incidence of death and HF(primary outcome). In 10 patients, we also studied the presence of transcardiac gradients for TNF- α and its soluble receptors. The control group comprised 45 healthy subjects who were sex and age matched(33 men; mean age, 65± 6 years) to the patients. All tested cytokines were increased in patients, and no transcardiac or systemic AV difference was found. After a median follow- up of 406 days(range, 346 to 696 days), 24 patients died and 32 developed HF. Univariate analysis showed that all cytokines were related to outcome, whereas after adjustment for baseline and clinical characteristics, sTNFR- 1 remained the only independent predictor of death and HF(hazard ratio, 2.9; 95% CI, 1.9 to 3.8, tertile 1 versus 3), together with left ventricular ejection fraction, Killip class, and creatine kinase- MB at peak. Conclusions sTNFR- 1 is a major short and long- term predictor of mortality and HF in patients with acute myocardial infarction.

关键词：急性心肌梗死 C-ALPHA 细胞因子激活肿瘤坏死因子 α受体射血分数可溶性受体细胞因子水平白细胞介素受体拮抗剂

急性心肌梗死患者中替罗非班大剂量快速注射后标准输注vs阿昔单抗输注以及西罗莫司洗脱支架vs裸金属支架的2×2析因比较:MULTI-STRAT-EGY试验的设计和原理

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世界核心医学期刊文摘（心脏病学分册） 2007年第10期3卷 51-52页

作者： valgimigli M. Bolognese L. Anselmi M. 黄欣 Cardiology University of FerraraFerraraItaly Dr.

背景:对于接受直接经皮冠状动脉介入的患者,当前的治疗标准支持早期输注阿昔单抗,然后置入裸金属支架(BMS)。使用西罗莫司洗脱支架(SES)能否进一步改善临床结局尚未证实。

关键词：阿昔单抗替罗非班替洛非巴西罗莫司洗脱支架 vs MULTI-STRAT-EGY 急性心肌梗死患者大剂量金属支架矿山支架输注

对累及无保护冠状动脉左主干的非分叉病变予药物洗脱支架置入后的良好长期预后:一项多中心注册研究

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世界核心医学期刊文摘（心脏病学分册） 2007年第11期3卷 40-41页

作者： Chieffo A. Park S.J. valgimigli M. A. Colombo 孙凯 San Raffaele Scientific Institute Via Olgettina 60 20132 Milan Italy Dr.

背景:无保护冠状动脉左主干开口和主干出现管腔狭窄但不需要施行分叉处理的病变,是外科血运重建的I类适应证。方法和结果:本项注册研究共纳入在5个中心进行治疗的147例无保护冠状动脉左主干开口处和(或)中段狭窄病变(不需要施行分叉治疗... 详细信息

背景:无保护冠状动脉左主干开口和主干出现管腔狭窄但不需要施行分叉处理的病变,是外科血运重建的I类适应证。方法和结果:本项注册研究共纳入在5个中心进行治疗的147例无保护冠状动脉左主干开口处和(或)中段狭窄病变(不需要施行分叉治疗)的连续患者,

关键词：左主干分叉病变冠状动脉注册研究置入

替罗非班加西罗莫司洗脱支架与阿昔单抗加裸金属支架治疗急性心肌梗死的随机对比试验

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世界核心医学期刊文摘（心脏病学分册） 2005年第10期1卷 24-25页

作者： valgimigli M. Percoco G. Malagutti P. 任付先 Department of Cardiology University of Ferrara Cardiovascular Institute CorsoGiovecca 203 44100 Ferrara Italy

Bare-metal stenting with abciximab pretreatment is currently considered a reasonable reperfusion strategy for acute ST-segment elevation myocardial infarction(STEMI). Sirolimus-eluting stents significantly reduce the need for target-vessel revascularization(TVR)vs bare-metal stents but substantially increase procedural costs. At current European list prices, the use of tirofiban instead of abciximab would absorb the difference in cost between stenting with sirolimus-eluting vs bare-metal stents. Abstract: To evaluate the clinical and angiographic impact of single high-dose bolus tirofiban plus sirolimus-eluting stenting vs abciximab plus bare-metal stenting in patients with STEMI. Design, Setting, and Patients: Prospective, single-blind, randomized controlled study(Single High Dose Bolus Tirofiban and Sirolimus Eluting Stent vs Abciximab and Bare Metal Stent in Myocardial Infarction[STRATEGY]) of 175 patients(median age, 63[interquartile range, 55- 72] years) presenting to a single referral center in Italy with STEMI or presumed new left bundle-branch block and randomized between March 6, 2003, and April 23, 2004. Intervention: Single high-dose bolus tirofiban regimen plus sirolimus-eluting stenting(n=87) vs standard-dose abciximab plus bare-metal stenting(n=88). Main Outcome Measures: The primary end point was a composite of death, non-fatal myocardial infarction, stroke, or binary restenosis at 8 months. Secondary outcomes included freedom, at day 30 and month 8, from major cardiac or cerebrovascular adverse events(composite of death, reinfarction, stroke, and repeat TVR). Results: Cumulatively, 14 of 74 patients(19% ; 95% confidence interval[CI], 10% - 28% ) in the tirofiban plus sirolimus-eluting stent group and 37 of 74 patients(50% ; 95% CI, 44% - 56% ) in the abciximab plus bare-metal stent group reached the primary end point(hazard ratio, 0.33; 95% CI, 0.18- 0.60; P< .001[P< .001 by Fischer exact test]). The cumulative incidence of death, reinfarction, strok

关键词：阿昔单抗裸金属支架替罗非班急性心肌梗死再梗死再狭窄非致死性左束支传导阻滞西罗莫司靶血管血运重建

在药物洗脱支架时代使用单支血管与分叉支架置入治疗冠状动脉左主干远端病变的比较:对RESEARCH(鹿特丹心脏病医院雷帕霉素洗脱支架评估)和T-SEARCH(鹿特丹心脏病变医院紫杉醇洗脱支架评估)注册研究的临床和血管造影认识

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世界核心医学期刊文摘（心脏病学分册） 2007年第4期3卷 9-10页

作者： valgimigli M. Malagutti P. Rodriguez Granillo G.A. P.W.Serruys 马超 Erasmus Medical Center ThoraxcenterRotterdamNetherlands Dr.

背景:新近发现,常规药物洗脱支架(DES)置入可改善接受冠状动脉左主干(LM)经皮治疗患者的预后。然而,即使是在DES时代,远端LM的治疗仍是不良预后的独立预测因素。应使用单支血管支架(SVS)

关键词：冠状动脉左主干 RESEARCH T-SEARCH 支血管支架置入治疗紫杉醇洗脱支架药物洗脱支

利用在体冠状动脉内超声射频数据分析评价的非罪犯病变冠状动脉斑块的构成与临床表现相关

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世界核心医学期刊文摘（心脏病学分册） 2006年第7期2卷 10-11页

作者： Rodriguez-Granillo G.A. Mc Fadden E.P. valgimigli M. P.W. Serruys 韩瑞娟 Erasmus Medical Center Thoraxcenter Rotterdam Netherlands Dr.

Background: Identification of subclinical high-risk plaques is potentially important because they may have greater likelihood of rupture and subsequent thrombosis. The purpose of this study was to assess the relationship between plaque composition determined by intravascular ultrasound(IVUS) radio frequency(RF) data analysis and clinical presentation. Methods: In 55 patients, a nonculprit vessel with< 50%diameter stenosis was studied with IVUS. Tissue maps were reconstructed from RF data using IVUS-Virtual Histology software. Results: Mean percentage of the different plaque components were 0.99%±0.9%, calcium; 68.04%±9.8%, fibrous; 19.31%±7.3%, fibrolipidic; and 9.43%±6.6%, lipid core. Mean lipid core percentage was significantly larger in patients with acute coronary syndrome(ACS) when compared with stable patients(12.26%±7.0%vs 7.40%±5.5%, P=.006). In addition, stable patients showed more fibrotic vessels(70.97%±9.3%vs 63.96%±9.1%, P=.007). There was no significant difference for either mean calcium(1.20%±1.1%vs 0.83%±0.7%, P=.124) or fibrolipidic(20.57%±6.9%vs 18.40%±7.6%, P=.281) percentages in ACS and stable patients, respectively. Vessel area obstruction did not differ between groups(46.49%±10.9%vs 42.83%±11.8%, P=.221). There was a significant, albeit weak, positive correlation between lipid core percentage and stenosis severity as determined by vessel area obstruction(r=0.34, P=.015). Conclusions: In this study, plaque characterization of nonculprit vessels using spectral analysis of IVUS RF data analysis was significantly related to clinical presentation. Percentage of lipid core, a feature related to acute coronary events and worse prognosis, was significantly larger in patients with ACS. Conversely, stable patients showed more fibrotic content.

关键词：冠状动脉斑块冠状动脉内超声罪犯血管血管内超声血管阻塞数据分析血栓形成数据重建虚拟组织

大剂量替罗非班静注对预防高危冠脉血管成形术缺血性并发症的额外价值:ADVANCE试验

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世界核心医学期刊文摘（心脏病学分册） 2005年第1期1卷 36-36页

作者： valgimigli M. Percoco G. Barbieri D. 王亭忠 Department of Cardiology University of Ferrara Ferrara ItalyDr.

Objectives We sought to determine the safety and efficacy of high-dose bolus( HDB) tirofiban in high-risk patients undergoing percutaneous coronary intervent ion(PCI). Background The use of HDB tirofiban in the catheterization laboratory is controversial. In particular, in patients with acute coronary syndromes under going PCI, there is no evidence that tirofiban administered in the catheterizati on laboratory is superior to heparin alone. This finding probably reflects the s uboptimal platelet inhibition when tirofiban is employed at RESTORE (Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis) regimen. Methods A tota l of 202 patients (mean age 69 ±8 years; 137 males >) undergoing high-ris k PCI, pretreated with thienopyridines, were consecutively randomized to HDB tir ofiban (25 μg/kg/3 min, and infusion of 0.15 μg/kg/min for 24 to 48 h) or plac ebo immediately before the procedure and then followed for a median time of 185 days (range 45 to 324 days) for the occurrence of the primary composite end poin t of death, myocardial infarction, target vessel revascularization (TVR), and ba ilout use of glycoprotein (GP) IIb/IIIa inhibitors. Results The cumulative incid ence of the primary end point was 35%and 20%in placebo and HDB tirofiban group s, respectively (hazard ratio 0.51, 95%confidence interval 0.29 to 0.88; p=0.01 ). This difference was mainly due to the reduction of myocardial infarction and bailout use of GP IIb/IIIa inhibitors, with no significant effect on TVR or deat h. The safety profile did not differ between tirofi-ban and placebo. Conclusion s The use of tirofiban, when administered at HDB, is safe and significantly redu ces the incidence of ischemic/thrombotic complications during highrisk PCI.

关键词：替罗非班血管成形术 ADVANCE 危冠复合终点事件冠脉介入手术急性冠脉综合征再狭窄血运重建随机研究

利用三支动脉血管内超声的射频数据分析描述冠状动脉斑块破裂表型的整体特征

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世界核心医学期刊文摘（心脏病学分册） 2007年第1期3卷 50-50页

作者： Rodriguez-Granillo G.A. Garca-Garca H.M. valgimigli M. P.W. Serruys 吴晓燕 Department of Cardiology Thoraxcenter Erasmus MC Bd-406 Dr Molewaterplein 40 3015-GD Rotterdam Netherlands

目的:比较伴或不伴冠状动脉树内斑块破裂(PR)证据的患者的整体特征,并应用血管内超声(IVUS)的射频数据分析(IVUS-VH)评价破裂斑块的表型。方法与结果:对40例患者进行三支动脉的IVUS-VH检查,其中在20例患者(占研究对象的50%)的26支血管(... 详细信息

目的:比较伴或不伴冠状动脉树内斑块破裂(PR)证据的患者的整体特征,并应用血管内超声(IVUS)的射频数据分析(IVUS-VH)评价破裂斑块的表型。方法与结果:对40例患者进行三支动脉的IVUS-VH检查,其中在20例患者(占研究对象的50%)的26支血管(占被研究血管的25.7%)中有28处诊断为PR。

关键词：冠状动脉斑块支动脉血管内超声斑块破裂支血管数据分析整体特征前降支管腔面积脂核

距开口距离是在体冠状动脉斑块成分的一项独立决定因素:基于射频数据分析的血管内超声研究

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世界核心医学期刊文摘（心脏病学分册） 2006年第8期2卷 21-21页

作者： valgimigli M. Rodriguez-Granillo G.A. Garcia-Garcia H.M. P.W. Serruys 杨海涛 Erasmus Medical Center Thoraxcenter Bd-406Dr Molewaterplein 40 3015- GDRotterdam Netherlands

Aims: Relative plaque composition, more than its morphology alone, is thought to play a pivotal role in determining propensity to vulnerability. Thus, we investigated in vivo whether the distance from coronary ostium to plaque location independently affects plaque composition in humans. This may help explaining the recently reported non-uniform distribution of culprit lesions along the vessel in acute coronary syndromes. Methods and results: In 51 consecutive patients(45 men), aged 38-76 years(mean age: 58± 10), a non-culprit vessel was investigated through spectral analysis of IVUS radiofrequency data(IVUS Virtual HistologyTM). The study vessel was the left anterior descending artery in 23(45% ) patients; the circumflex artery in nine(18% ), and right coronary artery in 19(37% ). The overall length of the region of interest, subsequently divided into 10 mm segments, was 41.5± 13 mm long(range: 30.2-78.4). No significant change was observed in terms of relative plaque composition along the vessel with respect to fibrous, fibrolipidic, and calcified tissue, whereas the percentage of lipid core resulted to be increased in the first(median: 8.75% ; IQR: 5.7-18) vs. the third(median: 6.1% ; IQR: 3.2-12)(P=0.036) and fourth(median: 4.5% ; IQR: 2.4-7.9)(P=0.006) segment. At multivariable regression analysis, distance from the ostium resulted to be an independent predictor of relative lipid content [β =-0.28(95% CI:-0.15,-0.41)], together with older age, unstable presentation, no use of statin, and presence of diabetes mellitus. Conclusion: Plaque distance from the coronary ostium, as an independent determinant of relative lipid content, is potentially associated to plaque vulnerability in humans.

关键词：冠状动脉斑块血管内超声成分距离开口超声研究数据分析急性冠状动脉综合征独立预测因素