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放线菌素洗脱支架用于冠状动脉血运重建的可行性和安全性的随机研究:ACTION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3期1卷 46-47页

作者： Serruys P.W. Ormiston J.A. Sianos G. 滕增辉

We sought to demonstrate the safety and performance of the actinomycin D-coated Multilink-Tetra stent(Guidant Corp., Santa Clara, California) in the treatment of patients with single de novo native coronary esions. Drug-eluting stents (DES) releasing sirolimus or paclitaxel dramatically reduce restenosis. The anti-proliferative drug, actinomycinD,which is highly effective in reducing neointimal proliferation in preclinical studies, was selected for clinical evaluation. The multi-center, single-blind, three-arm ACT inomycin-eluting stent Improves Outcomes by reducing Neointimal hyperplasia(ACTION) trial randomized 360 patients to receive a DES(2.5 or 10 μg/cm2 of actinomycin D) or metallic stent(MS). The primary end points were major adverse cardiac events(MACE) at 30 days, diameter stenosis by angiography, tissue effects, and neointimal volume by intravascular ultrasound(IVUS) at six months. When early monitoring revealed an increased rate of repeat revascularization, the protocol was amended to allow for additional follow-up for DES patients. Angiographic control of MS patients was no longer mandatory. The biased selection of DES patients undergoing IVUS follow-up invalidated the interpretation of the IVUS findings. The in-stent late lumen loss and that at the proximal and distal edges were higher in both DES groups than in the MS group and resulted in higher six-month and one-year MACE (34.8%and 43.1%vs. 13.5%), driven exclusively by target vessel revascularization without excess death or myocardial infarction. The results of the ACTION trial indicate that all anti-proliferative drugs will not uniformly show a drug class effect in the prevention of restenosis.

关键词： ACTION 随机研究洗脱支架抗增殖药放线菌素单支冠状动脉靶血管血运重建内膜增生不良心脏事件再狭窄

血BNP检测对ACS危险分层和预后判断的意义

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上海医学 2007年第S1期30卷 18-19页

作者：钱琦杜蕾蒋金法上海同济大学附属同济医院心内科上海200065

目的通过检测ACS和稳定型心绞痛(SA)患者及ACS各亚组患者入院时的血浆BNP、cTnI、hsCRP和白细胞(WBC)的浓度,评价BNP单独或和cTnI、hsCRP、WBC联合检测对ACS的危险分层和预后判断的意义。方法选择ACS患者67例为试验组,SA20例为对照组, ... 详细信息

目的通过检测ACS和稳定型心绞痛(SA)患者及ACS各亚组患者入院时的血浆BNP、cTnI、hsCRP和白细胞(WBC)的浓度,评价BNP单独或和cTnI、hsCRP、WBC联合检测对ACS的危险分层和预后判断的意义。方法选择ACS患者67例为试验组,SA20例为对照组, ACS组分为③个亚组:ST抬高心肌梗死(STEMI)组27例、非ST抬高心肌梗死组(NSTEMI)20例、不稳定型心绞痛(UA)20例。入院后24 h、5 d分别床旁测定血浆BNP、cTNI浓度,同时测hsCRP和WBC浓度,并查心电图、心超,行CAG术,记录患者病变的部位范围及各参数的值;并通过随诊访问患者或其家属了解30 d内、3个月内心血管事件(梗死后心绞痛、非致命性心肌梗死、心力衰竭、心律失常、靶血管血运重建及心脏性死亡)发生情况来判断预后。结果①ACS组和SA组之间的BNPI (559．59±735.) 16pg／ml比(23.28±11．69)pg／ml]的差异有统计学意义(P100 pg／ml时的敏感性为75％,特异为97％,正确性为81％。BNP预测3个月心血管事件的ROC曲线下面积(AUC)为0．787 (95％CI为0．672-0．902;P血管事件发生率分别为56．5％、55．0％、51．0％、75．0％和80．0％。结论血BNP水平与ACS疾病严重程度有关,BNP水平高多见于前壁心梗、血管病变数量多和心衰程度严重者,并与心血管事件呈正相关,故BNP是ACS危险分层和预后的独立预测因子:同时联合检测cTNI、hs CRP、WBC后评估ACS风险和预后的作用更大。从而有利于判断临床预后与拟订合适的治疗方案。

关键词：危险分层 ACS BNP 心血管事件心肌梗死组靶血管血运重建不稳定型心绞痛致命性心肌梗死心脏性死亡心衰程度

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

成功置入冠状动脉支架后使用西洛他唑和氯吡格雷的对比研究

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世界核心医学期刊文摘（心脏病学分册） 2005年第9期1卷 32-33页

作者： Lee S.-W. Park S.-W. 李天霞 Dr.Department of Medicine Univ. of Ulsan College of Medicine Asan Medical Center Seoul South Korea

This study compared the safety and efficacy of cilostazol and clopidogrel after coronary stenting. Patients(n=689) who underwent successful stenting were randomly assigned to receive cilostazol(group 1, n=344, 612 lesions) or clopidogrel(group 2, n=345, 628 lesions). The incidence of subacute stent thrombosis or major adverse cardiac events, including death, myocardial infarction, and target lesion revascularization within 30 days(2.6%in group 1 vs 2.0%in group 2, p=0.61) and side effects that required cessation of study drug(0.6%each) did not differ statistically between groups. These results indicate that cilostazol is as safe and effective as clopidogrel in preventing thrombotic complications after stenting.

关键词：冠状动脉支架西洛他唑靶血管血运重建不良心脏事件血栓形成使用研究

下肢动脉硬化闭塞症支架内再狭窄的腔内治疗研究进展

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山东医药 2019年第7期59卷 98-101页

作者：张丹刘明郝清智赵波赵亚男张大伟山东中医药大学济南250014 山东中医药大学附属医院

经皮穿刺动脉介入手术血管支架置入是动脉硬化闭塞症的常规治疗方法,而支架内再狭窄(ISR)是导致病情反复甚至恶化的重要原因之一。目前用于治疗支架内再狭窄的技术主要有球囊血管成形术(PTA)、金属裸支架(BMS)重复置入、准分子激光斑块... 详细信息

经皮穿刺动脉介入手术血管支架置入是动脉硬化闭塞症的常规治疗方法,而支架内再狭窄(ISR)是导致病情反复甚至恶化的重要原因之一。目前用于治疗支架内再狭窄的技术主要有球囊血管成形术(PTA)、金属裸支架(BMS)重复置入、准分子激光斑块消蚀术、斑块旋切术、切割球囊、药物洗脱支架(DES)置入、药物洗脱球囊(DCB)成形术等。PTA及DCB成形术的可重复性好,但是PTA远期通畅率不佳,DCB则拥有较好的结果;BMS重复置入及DES置入短期内可获得较好的有效管腔,DES的通畅率相当可观,但重复支架的使用终将会面临更加严重的ISR,并且支架断裂风险也会成倍增加;斑块旋切术等减容技术的兴起,为ISR的治疗提供了新选择,机械或激光消融在技术成功的前提下,都具有良好的通畅率,但其昂贵的费用,限制了该技术的大范围使用。

关键词：支架内再狭窄球囊血管成形术药物洗脱支架金属裸支架药物洗脱球囊靶血管血运重建腔内治疗

口服雷帕霉素抑制冠状动脉原发病变支架植入术后再狭窄:口服西罗莫司抑制再狭窄(ORBIT)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2期1卷 54-55页

作者： Waksman R. Ajani A.E. Pichard A.D. 陶蕾

The aim of this study was to establish safety and feasibility of oral Rapamyci n at two doses -2 mg and 5 mg -in achieving low rates of repeat target lesion revascularization (TLR) in de novo native coronary artery lesions. Drug eluting stents have shown the ability to limit restenosis. Oral Rapamycin is an alterna tive strategy that can target multiple coronary lesions suitable for treatment w ith any approvedmetal stent and at potentially lower cost. The Oral Rapamune to Inhibit Restenosis (ORBIT) study is an open label study of 60 patients with de novo lesions treated with bare metal stents in up to two vessels. After a loadin g dose of 5 mg, patients received a daily dose of 2 mg (n=30) and 5 mg(n=30) for 30 days. Six month angiographic, intravascular ultrasound(IVUS), and clinical follow up were conducted. Baseline clinical and procedural characteristics were similar: 10%of patients in the 2-mg group and 30%in the 5-mg group did not complete the course; 43%in the 2-mg group and 66%in the 5-mg group had side effects. At six month follow up, late loss (0.6 ±0.5 mm vs. 0.7 ±0.5 mm; p=N S), in stent binary restenosis (7.1%vs. 6.9%; p=NS), in stent percent volume obstruction by IVUS (29%vs. 24%; p=NS), and clinically driven TLR (14.3%vs. 6.9%; p=NS) were similar in 2-mg and 5-mg groups. Oral Rapamycin for the prev ention of restenosis is safe, feasible, and associated with low rates of repeat revascularization. Although associated with certain side effects, it may be cons idered for patients undergoing multivessel stents if proven in larger randomized studies.

关键词：再狭窄 ORBIT 原发病变西罗莫司支架植入术靶血管血运重建负荷剂量裸金属支架血管内超声检查金属支架植入

非ST段抬高型心肌梗死患者冠状动脉完全闭塞的发生率及对预后的影响

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中国循证心血管医学杂志 2019年第10期11卷 1197-1200页

作者：朱红涛刘学庆芮立美张友明丁晓军赵剑峰李斌义邱林林江苏省丹阳市人民医院心内科丹阳212300 江苏省丹阳市人民医院超声科丹阳212300

目的观察非ST段抬高型心肌梗死(NSTEMI)患者罪犯血管完全闭塞的分布及对预后的影响。方法选取2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者为研究对象,根据冠状动脉(冠脉)造影TIMI血流分级结果,分为完全闭塞组(T... 详细信息

目的观察非ST段抬高型心肌梗死(NSTEMI)患者罪犯血管完全闭塞的分布及对预后的影响。方法选取2014年1月至2017年12月于丹阳市人民医院心内科住院的192例NSTEMI患者为研究对象,根据冠状动脉(冠脉)造影TIMI血流分级结果,分为完全闭塞组(TIMI血流0级,n=30)及非完全闭塞组(TIMI血流1~3级,n=162)。分析NSTEMI患者冠脉完全闭塞的发生率及分布,并评估患者住院期间及出院30 d、90 d、180 d心脏猝死、复发性非致命性心肌梗死、靶血管血运重建及卒中发生率。结果 192例患者中,总共30例(15.6%)罪犯血管完全闭塞,其中前降支5例(16.7%)、回旋支14例(46.7%)和右冠11例(36.7%)。与非完全闭塞组相比,完全闭塞组患者年龄较低,低密度脂蛋白胆固醇(LDL-C)更高,入院时TIMI积分高,差异均有统计学意义(P血管完全闭塞的独立预测因子。住院期间及30 d完全闭塞组的主要复合终点事件发生率高(P0.05)。结论 30例(15.6%)NSTEMI患者罪犯血管完全闭塞,180 d两组患者主要心血管终点事件无明显差异,入院时患者TIMI积分及LDL-C水平可以作为冠状动脉完全闭塞的独立预测因子。

关键词：非ST段抬高型心肌梗死冠状动脉完全闭塞心脏猝死非致命性心肌梗死靶血管血运重建

轻度或中度慢性肾脏疾病对冠状动脉再狭窄发生率的影响:来自PRESTO试验的结果

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世界核心医学期刊文摘（心脏病学分册） 2005年第3期1卷 53-54页

作者： Best P.J.M. Berger P.B. Davis B.R. 杜媛

The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease (CKD) patients after percutaneous coronary intervention (PCI). Mortality is increased in CKD after PCI. Restenosis may contribute to increased late mortality. We analyzed 11,187 patients with a creatinine >1.8 mg/dl from the Prevention of REStenosis with Tranilast and its Outcomes (PRESTO) trial, grouped by estimated creatinine clearance(CrCl)(89ml/min). The Cox proportional hazards models investigated the association between CrCl group and death, myocardial infarction, and target vessel revascularization(TVR). Generalized estimating equation regression models determined the association between CrCl group and lesion-specific restenosis. At 30 days, therewas no difference in myocardial infarction, death, or TVR between the CrCl groups. At nine months, mortality was higher in the lowest CrCl group(2.2%, 1.2%, 0.8%; p >0.001), which was no longer significant after adjusting for confounding variables. Myocardial infarction and TVR were not different between the groups. In patients undergoing protocol follow-up angiography, restenosis(< 50%) was not increased with CKD(32%, 32%, 37%; p=0.02). Mortality nine months after PCI is mildly increased in mild or moderate CKD patients. However, restenosis is not and does not account for the increased mortality.

关键词：慢性肾脏疾病 PRESTO 再狭窄发生率慢性肾病靶血管血运重建肌酐清除率晚期死亡曲尼司特肌酐水平混杂变量

8项首次报告研究公布 CIT2015:中国重要原创研究“展示台”

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中国医药科学 2015年第7期5卷 4-8页

作者：苏暄 <中国医药科学>

又是一个明媚的春天,中国介入心脏病学大会（CIT）于2015年3月19日在北京隆重开幕。大会秘书长、中国医学科学院阜外心血管病医院徐波教授介绍,12年来,CIT已成为具有广泛国际学术影响力的品牌会议,是国内介入心脏病学领域规模最大的国... 详细信息

又是一个明媚的春天,中国介入心脏病学大会（CIT）于2015年3月19日在北京隆重开幕。大会秘书长、中国医学科学院阜外心血管病医院徐波教授介绍,12年来,CIT已成为具有广泛国际学术影响力的品牌会议,是国内介入心脏病学领域规模最大的国际学术会议;CIT已成为展示、宣传、促进、构建我国介入心血管原创数据库,弘扬推进原创研究对临床实践指导意义的重要平台。作为CIT大会一直以来的关注焦点,

关键词：介入心脏病学 CIT2015 大会秘书长展示台品牌会议靶病变血运重建靶血管血运重建学术会议支架内血栓缺血性卒中