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Effects of upstream tirofiban versus downstream tirofiban on myocardial damage and 180-day clinical outcomes in high-risk acute coronary syndromes patients undergoing percutaneous coronary interventions

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Chinese Medical Journal 2009年第15期122卷 1732-1737页

作者： LIU Tao XIE Ying ZHOU Yu-jie LI Yue-ping MA Han-ying GUO Yong-he LIU Yu-yang ZHAO Ying-xin SHI Dong-mei Department of Geriatric Cardiology Beijing Anzhen Hospital Affiliated to Capital Medical University Beijing 100029 China

Background For patients with moderate to high-risk acute coronary syndromes （ACS） who undergo early, invasive treatment strategies, current guidelines recommend the usage of glycoprotein （GP） lib/Ilia inhibitors as an upstream treatment for a coronary care unit or as an downstream provisional treatment for selected patients who are undergoing percutaneous coronary intervention （PCI）. The relative advantage of either strategy is unknown. The purpose of this study was to evaluate the effects of upstream tirofiban versus the effects of downstream tirofiban on myocardial damage and 180-day major adverse cardiovascular events （MACE） after PCI in high-risk non-ST-segment elevation ACS （NSTE-ACS） undergoing PCI. Methods From July 2006 to July 2007, 160 high-risk NSTE-ACS undergoing PCI were randomized to receive upstream （within 4-6 hours before coronary angiography） tirofiban or downstream （the guidewire crossing the lesion） tirofiban, to evaluate the extent of myocardial damage after PCI by quantitatively and qualitatively analyzing the value of cardiac troponin I （cTnl） as well as MB isoenzyme of creatine kinase （CK-MB） before and after PCI. The incidences of 24-hour, 3-day, 7-day, 30-day and 180-day MACE after PCI were followed up and the rates of bleeding complications and thrombocytopenia during tirofiban administration were recorded. Results The peak release and cumulative release of cTnl levels within 48 hours after PCI were significantly lower with upstream tirofiban than downstream tirofiban （0.45 vs 0.63 and 0.32 vs 0.43, respectively; P 〈0.05）. Post-procedural cTnl elevation within 48 hours was significantly less frequent among patients who received the upstream tirofiban than those who received the downstream tirofiban （66.3% vs 87.5%, P 〈0.05）. The peak and cumulative release of CK-MB levels as well as post-procedural CK-MB elevation within 48 hours after PCI were not significantly different between the two groups （16 vs 14,5 vs 3 and 26.3% vs 36.3%, respecti

关键词： tirofiban coronary syndrome, acute angioplasty, transluminal, percutaneous coronary

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Predictive value of postprocedural leukocyte count on myocardial perfusion, left ventricular function and clinical outcomes in ST-elevated myocardial infarction after percutaneous coronary intervention

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Chinese Medical Journal 2012年第6期125卷 1023-1029页

作者： HE Rong LI Hai-yan GUO Li-jun ZHANG Fu-chun NIU Jie ZHANG Yong-zhen WANG Gui-song YANG Zhen-hua GAO Wei Department of Cardiology Peking University Third HospitalKey Laboratory of Cardiovascular Molecular Biology and Regulatory PeptidesMinistry of HealthKey Laboratory of Molecular Cardiovascular SciencesMinistry of EducationBeijing 100191China

Background Baseline white blood cell （WBC） count was correlated with ischemic events occurrence in patients with ST-elevated myocardial infarction （STEMI）. However, circulating WBC count is altered after percutaneous coronary intervention （PCI）. The aim of this study was to assess the relationship between postprocedural WBC count and clinical outcomes in STEMI patients who underwent PCI. Methods A total of 242 consecutive acute STEMI patients who underwent successful primary PCI were enrolled and followed up for two years. WBC counts were measured within 12 hours after PCI. ST-segment resolution （ST-R） and myocardial blush grades （MBG） were evaluated immediately after PCI. Left ventricular ejection fraction （LVEF） was obtained at baseline and 12-18 months after PCI. Results Postprocedural WBC count was an independent inverse predictor of ST-R （OR 0.80, P 〈0.0001） and MBG 3 （OR 0.82, P 〈0.0001）. It was negatively correlated with LVEF （baseline r=0.22, P=0.001; 12-18 months r=0.29, P 〈0.0001）. The best cutoff value of WBC for predicting death was determined to be 13.0×10^9/L. The patients with a postprocedural WBC count above 13.0×10^9/L showed a significantly lower cumulative survival rate （30 days, 82.4% vs. 99.0%, P 〈0.0001 and 2 years 75.0% vs. 96.4%, P 〈0.0001）. Multivariate Cox regression analysis showed that a postprocedural WBC count was a strong independent predictor of 30-day mortality （HR 8.48, P=0.019） and 2-year mortality （HR 4.93, P=0.009）. Conclusions Increased postprocedural WBC count is correlated with myocardial malperfusion and left ventricular dysfunction, and is an independent predictor of poor clinical outcomes in STEMI patients who underwent PCI.

关键词： angioplasty, transluminal, percutaneous coronary leukocyte myocardial infarction left ventricular dysfunction prognosis

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Clinical Observation on Shu Xin Yi Mai Capsules for Prevention of Recurrent Stricture after coronary Artery Introducing Treatment

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Journal of Traditional Chinese Medicine 2003年第1期23卷 3-6页

作者：段学忠杨丁友张蕴慧周次清王友京 TCM Section General Hospital of PLA Jinan Military RegionJinan 250031Shandong Province The Affiliated Hospital of Shandong TCM University

Shu Xin Yi Mai Capsules (舒心益脉胶囊) combined with western medicine was used in the routine treatment of 22 cases who successfully received coronary artery introducing therapy (Chinese-western medicine group),and the results was compared with the 26 cases treated routinely with simple western medicine in the control group (western medicine group).It was found that both the recurrence rate of angina pectoris and the incidence rate of recurrent stricture in the Chinese-western medicine group were significantly lower than that in the control group (both P<0.05).There was no significant difference between the two groups in expression of platelet activating molecules CD62P (a-granular membrane protein),CD63 (lysosome intact membrane protein) and CD41 (glucoprotein IIb) before the treatment,but with a significant difference after the treatment (P<0.05).

关键词： Phytotherapy Adult Aged Angina, Unstable angioplasty, transluminal, percutaneous coronary Antigens, CD Blood Platelets Capsules coronary Restenosis Drugs, Chinese Herbal Female Follow-Up Studies Humans Male Middle Aged Myocardial Infarction P-Selectin Platelet Membrane Glycoprotein IIb Platelet Membrane Glycoproteins

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A high maintenance dose of clopidogrel improves short-term clinical outcomes in patients with acute coronary syndrome undergoing drug-eluting stent implantation

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Chinese Medical Journal 2009年第7期122卷 793-797页

作者： HAN Ya-ling WANG Bin LI Yi XU Kai WANG Shou-li JING Quan-min WANG Zu-lu WANG Dong-mei MA Ying-yan WANG Geng Department of Cardiology Shenyang Northern HospitalShenyang Liaoning 110016 China

Background Recurrent ischemic events occurred even during routine use of 75 mg clopidogrel in addition to aspirin, that indicated a potentially insufficient maintenance dosage of clopidogrel. The aim of the present study was to evaluate the short-term efficacy and safety of a 150 mg maintenance dose of clopidogrel following a 600 mg loading dose in patients with an acute coronary syndrome （ACS） undergoing drug eluting stent （DES） implantation. Methods Between November 2005 and November 2006, a total of 813 consecutive ACS patients undergoing DES implantation were enrolled. A 600 mg loading dose was administered before percutaneous coronary intervention （PCI） and patients were randomized to receive clopidogrel 75 mg or 150 mg for 30 days in addition to 300 mg aspirin daily. Primary end points were the composite of cardiac death, non-fatal myocardial infarction （MI） and urgent target vessel revascularization （UTVR）. Secondary end points included stent thrombosis （ST）, major and minor bleeding events at 30 days. Results At a follow-up period of 30 days, 4 （1.0%） patients in the 150 mg group and 9 （2.2%） patients in the 75 mg group （P 〉0.05） reached the primary end points. There was no significant difference in the incidences of MI （0.5% vs 1.2%, P〉0.05）, UTVR （0.7% vs 2.0%, P 〉0.05）, and cardiac death （0.2% vs 0.2%, P 〉0.05） between the two groups. The incidence of ST （0 vs 1.5%, P 〈0.05） was significantly lower in the 150 mg group than that in the 75 mg group. There were no significant differences between both groups regarding the risk of major （0.2% vs 0, P 〉0.05） or minor （0.5% vs 0.2%, P 〉0.05） bleedings. Conclusion A high clopidogrel maintenance dose of 150 mg daily following a 600 mg loading dose for the first month after PCI procedure reduces the risk of ST and appears to be safe in patients with ACS undergoing DES implantation.

关键词： angioplasty, transluminal, percutaneous coronary clopidogrel maintenance dose

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Primary intracoronary stenting in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary intervention in patients with acute myocardial infarction

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Chinese Medical Journal 2002年第2期115卷 163-165,144页

作者：蔡煦张瑞岩张建盛沈卫峰 SHEN Weifeng 张大东上海第二医科大学附属瑞金医院心脏科上海200025 Ruijin Hospital Shanghai Second Medical University Shanghai 200025 China

OBJECTIVES: To compare primary stenting in the infarct-related coronary artery with intravenous rt-PA therapy plus rescue intracoronary stenting. METHODS: Ninety-eight patients with a first acute myocardial infarction (AMI) were randomly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stenting (thrombolysis plus stenting group). Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular ejection fraction, LVEF) was calculated by echocardiography before discharge between the two groups. RESULTS: There were 47 patients (97.91%) in primary stenting group and 50 patients (100%) in thrombolysis plus stenting group had achieved TIMI grade 2 - 3 flow after the procedure. But the former had more cases (93.8%) of TIMI 3 flow than that of latter (60.0%, P = 0.0001). There was no difference between the two groups in cardiac events during hospitalization. But the patients in primary stenting group had better cardiac function (LVEF 0.62 +/- 0.14 vs. 0.50 +/- 0.12, respectively, P = 0.0001) between the two groups. CONCLUSIONS: Primary intracoronary stenting may improve myocardial reperfusion in emergency and inhibit the decline of cardiac function after AMI in comparison with intravenous rt-PA thrombolysis plus rescue intracoronary stenting.

关键词： Stents Aged angioplasty, transluminal, percutaneous coronary Combined Modality Therapy Comparative Study Creatine Kinase Female Fibrinolytic Agents Humans Infusions, Intravenous Isoenzymes Male Middle Aged Myocardial Infarction Recombinant Proteins Tissue Plasminogen Activator Treatment Outcome

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Clinical characteristics of acute ischemic syndrome in China

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Chinese Medical Journal 2002年第8期115卷 1123-1126页

作者：无 Tan HQ Liang Y Zhu J Liu LS Cronin L The Chinese Coordinating Center of OASIS Registry Emergence Department Cardiovascular Institute and Fu Wai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBering 100037China Division of Cardiology.Mc Master University Canada

OBJECTIVE: To analyse the characteristics and therapies of patients with acute ischemic syndrome in China.　 METHODS: This study is part of the international multicentre registry for acute ischemic syndrome. Since April 1999, the data of patients admitted to designated hospitals with acute ischemic cardiac chest pain were collected by filling in Case Report Forms offered by the Canadian Cardiovascular Collaboration. The main clinica l characteristics and in　hospital events of the patients were recorded.　 RESULTS: Fifteen hundred and nine cases of acute ischemic syndrome from 34 hospitals nationwide were enrolled in the registry (including unstable angina and non Q-wave myocardial infarction).The mean age of the patients was 62.3. Male dominance (62.2%) was noted. The percentages of patients with chest pain at presentation and abnormal ECG were 47.8% and 89.5%, respectively. The most common clinical diagnosis on admission was unstable angina, accounting for 91.3% of the patients and non Q-wave myocardial infarction (MI), accounting for the other 8.7%. During hospitalization, the following interventions were given: thrombolytic therapy in 50 cases (3.3%), coronary angiography in 528 cases (35.0%), percutaneous transluminal coronary angioplasty (PTCA) in 253 cases (16.8%) and coronary artery bypass graft surgery (CABG) in 62 cases (4.1%). Nitrate (oral or patch ) and anti-platelet therapy were used in 1460 cases (96.8%) and 1441 cases (95.5%), respectively. The incidence of in　hospital major events was 18.8%, in cluding 18 deaths (1.2%), with the most common causes being severe arrhythmias and sudden death.　 CONCLUSIONS: Patients with acute ischemic syndrome in China have mostly been diagnosed as cases of unstable angina. A relatively high PTCA rate but low CABG rate was noted in China. The most common cause of in　hospital death is severe arrhythmias or sudden death.

关键词： Adult Aged angioplasty, transluminal, percutaneous coronary China coronary Angiography coronary Artery Bypass Female Humans Male Middle Aged Myocardial Ischemia Research Support, Non-U.S. Gov't

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Treatment of in stent coronary restenosis with excimer laser angioplasty

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Chinese Medical Journal 2000年第1期113卷 14-17页

作者： Meilin Liu W.H.Chow O.H.Kwok M.H.Jim A.Yip K.Fan E.Chan Department of Cardiology First Teaching HospitalBeijing Medical UniversityBeijing 100034China Cardiac Medical Unit Grantham HospitalHong KongChina

OBJECTIVE: To evaluate the efficacy and safety of excimer laser coronary angioplasty (ELCA) with adjunctive balloon angioplasty in patient with in-stent restenosis. METHODS: ELCA was performed in 20 patients of instent restenosis. All patients were symptomatic and had class III-IV angina. ELCA was performed with the Spectranetics CVX-300 System. The laser catheter of Vittesse C (concentric) and E (eccentric) with diameter of 1.4-2.0 mm was used. RESULTS: Laser catheter crossed all stenotic stents without difficulty. The lesion length was 4.6-51.2 mm, mean 20.7 +/- 13.7 mm, including 14 lesions > 10 mm. Laser treatment alone increased minimal lumen diameter (MLD) from 0.3 +/- 0.3 mm to 1.4 +/- 0.3 mm (P

关键词： angioplasty, Balloon, Laser-Assisted Stents Aged Aged, 80 and over angioplasty, transluminal, percutaneous coronary coronary Restenosis Female Humans Male Middle Aged

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Long-term efficacy and safety of drug-eluting stent implantation for patients with multiple coronary chronic total occlusions

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Chinese Medical Journal 2010年第7期123卷 789-793页

作者： ZHANG Jian HAN Ya-ling LI Yi WANG Shou-li JING Quan-min WANG Xiao-zeng MA Ying-yan LUAN Bo WANG Geng WANG Bin Department of Cardiology Shenyang Northern HospitalShenyang Liaoning 110016 China

Background Data on the efficacy and safety of drug-eluting stent （DES） for treatment of multiple coronary chronic total occlusion （CTO） lesions are scanty. The aim of the present study was to compare the long-term outcomes of DES versus bare metal stent （BMS） implantation for multiple coronary CTO *** We analyzed 188 patients who underwent coronary stenting for at least two de novo CTO lesions in our center from November 2000 to November 2006. Among them, 118 patients （62.8%） received DES and 70 patients （37.2%） received BMS implantation after the recanalization for CTO lesions. All patients were followed up for up to 5 years for the occurrence of major adverse cardiac events （MACE）. Long-term survival rates were estimated with the Kaplan-Meier *** There were no significant differences in baseline clinical characteristics and procedural success rate between DES group and BMS group. Compared with the BMS group, the DES group showed a significantly higher rate of long CTO （≥15 mm）（62.0% vs. 50.6%, P=0.023）. The number of stents per lesion （1.39±0.71 vs. 1.17±0.66, P=0.007） and the mean length of stents in the DES group were also higher than those in the BMS group （（40.8±11.4） mm vs. （23.4±8.7） mm, P〈0.001）. But the mean diameter of stents in the DES group was smaller than that in the BMS group （（3.1 ±0.2） mm vs. （3.3±0.5） mm, P〈0.001）. Average follow-up time was 4.8±0.7 （1.5-5.0） years in the BMS group and 4.3±0.5 （1.3-5.0） years in the DES group. Both the 5-year cumulative survival rates and the target vessel revascularization （TVR）-free survival rates of the DES group were significantly higher than those in the BMS group （83.1% vs. 72.9%, Log-rank P=0.044; 77.1% vs. 62.9%, Log-rank P=0.009）. The cumulative MACE-free survival rates in the DES group were significantly higher than those in the BMS group （71.2% vs. 51.4%, Log-rank P=0.001）. Multivariable Cox regression analysis demonstrated that DES implantation for multiple CTO lesions could sig

关键词： chronic disease coronary disease angioplasty, transluminal, percutaneous coronary stents

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Stent supported coronary angioplasty in patients with severe ventricular dysfunction

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Chinese Medical Journal 2002年第3期115卷 355-358页

作者：李成祥贾国良郭文怡李伟杰第四军医大学西京医院心内科西安710033

OBJECTIVE: To assess the immediate- and long-term outcomes of stent supported coronary angioplasty in patients with severe left ventricular dysfunction. METHODS: Seventy-four consecutive patients with angiographic left ventricular ejection fractions or = 1 was seen in 29 (73%) of 40 successfully treated congestive heart failure patients at 6 months after the procedure. During long-term follow-up, 58 (87.9%) of 66 patients with clinical success were alive, including 44 (68.6%) free from cardiac events. CONCLUSIONS: Patients with severe left ventricular dysfunction treated with stent supported PTCA experience a high rate of success, low procedure related mortality and satisfactory long-term survival.

关键词： Stents Adult Aged angioplasty, transluminal, percutaneous coronary Female Follow-Up Studies Humans Male Middle Aged Ventricular Dysfunction, Left

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