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Objective To explore the effectiveness and safety of branch protection technique with provisional stenting strategy in coronary bifurcation lesions by utilizing jailed balloon protection technique after pre-dilation in branch with cutting balloon. Methods 32 patients undergone jailed balloon protection technique after pre-dilation in branch with cutting balloon during January, 2015 to May, 2016 in Peking University of People's Hospital were enrolled consecutively in our study. 32 patients were involved including a total of 32 bifurcation lesions which were medina type 1,1,1 (n = 25, 78. 1% ), Medine type 0,1,1 (n =5,15. 6% ) and Medine type 1,0,1 (n = 2, 6. 3% ). For side branch diameter ≥2. 5 mm, the diameter ratio of cutting balloon to side branch was 1: 1. The angiography success rate after using branch protection during main branch stent implantation, perioperative complications and major adverse cardiac events were observed. Results ( 1 ) The angiography success rate of branch protection was 100% . ( 2 ) No perioperative complications and major adverse cardiac events were observed. Conclusions Side branches were effectively protected in provisional stenting strategy by applying jailed balloon protection technique after pre-dilation using branch cutting balloon.
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Objective To investigate the safety and short-term outcome of rotational atherectomy followed by drug-eluting stenting in heavily calcified coronary long lesions. Methods From Jan 1, 2011 to May 31, 2016, 109 cases with 114 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stenting in Peking University People's Hospital were included. They were divided into diffuse lesion group ( lesion ≥25 mm, 68 cases, 72 lesions ) and focal lesion group (lesion ﹤25 mm,41 cases, 42 lesions). All patients were followed up in hospital. Procedure parameters, procedural complications ( dissection, perforation, slow flow/no flow and procedural related myocardial infarction),procedural success and major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction and stent thrombosis) were analyzed. Results The procedural success rate was 98. 5%(67/68) in diffuse lesion group and 100% ( 41/41 ) in focal lesion group ( P=0. 453 ) . Complication rates did not differ between the two groups (41. 2% and 34. 1%, P=0. 673). Major adverse cardiovascular events rates were 41. 2% and 31. 7%, P =0. 484. Conclusions Treating coronary lesions ≥25 mm in length with rotational atherectomy followed by drug-eluting stenting does not impact the short-term outcome when treating carefully and correctly . Procedural success rate and in-hospital outcome is satisfactory.
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Objective: To explore the application safety for off-label using of rotational atherectomy. Methods: A total of 112 patients received rotational atherectomy in our hospital from 2010-01 to 2015-12 were enrolled in this study. There were 9 off-label indications for using of rotational atherectomy which included vein grafts, massive thrombotic burden, unprotected left main coronary artery disease, culprit lesions of acute myocardial infarction, severe coronary dissection, signiifcant impaired left ventricular function (LVEF0.05.②Off-label group had 1 patient with stuck of rotablator (1.5% vs 0%) and 1 cardiac death (1.5% vs 0%), both P>0.05; On-label group had 1 patient with acute in-stent thrombosis (2.2% vs 0%),P>0.05. Conclusion: Off-label using of rotational atherectomy did not increase the incidence of slow lfow/no lfow in relevant patients, other severe complications and in-hospital MACE occurrence were also rare.
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Objective: Based on scores by number of vessels diseased and age (NVDA), the minimum lumen area (MLA) of left anterior descending (LAD) proximal or middle intermediate lesions were examined by intravascular ultrasound (IVUS) to analyze the clinical characteristics, to ifnd the factors affecting lumen area and to establish a scoring system for predicting MLA in relevant patients. Methods: A total of 90 patients were enrolled including 58 male and 32 female with the age of (41-77) years. The demographic information, medical history and laboratory results were studied by simple linear regression analysis to screen relevant factors affecting MLA; multi regression analysis was conducted to establish a regression equation for predicting MLA and to calculate the risk factor coefifcient for obtaining relevant scoring system. Results: NVDA score≤4 was deifned as negative result with speculated MLA≥3.0mm2, while NVDA score>4 was deifned as positive result with speculated MLA Conclusion: NVDA scoring system had the better accuracy, sensitivity and speciifcity for predicting MLA in coronary artery intermediate lesions, it had certain value for guiding coronary interventional therapy in relevant patients.
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Objective To investigate the relationship between the Minimum Lumen Area (MLA) and plaque burden(PB) of the left circumlfex (LCX) ostial and the occurrence of myocardial ischemia after a single stent crossover for the treatment of left main (LM) bifurcated lesions. Methods Intravascular ultrasound (IVUS) assessment was performed on 5 patients, each where coronary angiography showed left main bifurcated lesions, and to measure the MLA and PB of the LCX. Following a single stent crossover fractional lfow reserve (FFR) evaluation were performed in all 5 patients to investigate the relationship between the MLA and PB of the LCX ostium and the occurrence of myocardial ischemia. Results The mean MLA of the left main coronary of the 5 patients was (4.99±2.3) mm2 with the minimum lumen diameter (MLD) being (2.26±2.8) mm. The average MLA of the left anterior descending (LAD) ostial or proximal was (4.01±2.0) mm2, mean plaque burden (PB) at the LAD ostial or proximal was (68.15±10.1)%. Average MLA of LCX was (4.94±0.4) mm2 with a plaque burden of (66.00±6.0)%. Single stent crossover technique was used to treat the bifurcated lesions. Among the 5 patients, only 1 of them was treated with a double stent deployment where the LCX ostial FFR was0.75. Conclusions Integrated IVUS and FFR would achieve threshold measurements of MLA at LCX’s ostium which could predict ischemia after one stent strategy.
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<p><b>OBJECTIVE</b>To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.</p><p><b>METHODS</b>Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.</p><p><b>RESULTS</b>The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P < 0.001). Recurrent myocardial infarction, and selective coronary stenting of patients with thrombolytic therapy were higher than that of patients in the primary stenting group (7.6% vs 1.5%, P < 0.05; 20.6% vs 0, P < 0.001, respectively). Left ventricular ejection fraction (LVEF) in patients in the thrombolysis group was lower than that of the stent group (55.6% +/- 13.4% vs 65.8% +/- 9.2%, P < 0.001). Total hospitalization time of the thrombolysis group was longer than that of the stent group (16 +/- 7 d vs 11 +/- 4 d, P < 0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%, P > 0.05).</p><p><b>CONCLUSION</b>Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.</p>
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Adult , Aged , Female , Humans , Male , Middle Aged , Myocardial Infarction , Therapeutics , Recombinant Proteins , Therapeutic Uses , Stents , Thrombolytic Therapy , Tissue Plasminogen Activator , Therapeutic UsesABSTRACT
Objective:To define impact of spontaneous TIMI-3 flow before angioplasty on outcomes of percutaneous coronary intervention strategy and the prognosis in patients with acute myocardial infarction (AMI ). Methods: The consecutive 301 patients enrolled in the ongoing register of emergent coronary angioplasty within 12 hours from symptoms who were diagnosed as having ST elevation AMI in our hospital from 2000 to 2006 were analyzed, they were followed up for one year and the clinical characteristics and survival rates were analysed. Results: Among the 301 patients enrolled in the ongoing register of emergent coronary angioplasty, spontaneous reperfusion (TIMI-3 flow) was present in 14.6% at initial angiography. Compared with patients without TIMI-3 flow, those with TIMI-3 flow before coronary intervention were less likely to present in new-onset heart failure(2.3% versus 16%, P=0.016), Patients with initial TIMI-3 flow had significantly lower 30-day mortality (0% versus 9.3%, P=0.035) , and cardiogenic shock (0%versus 8.6%, P=0.044) and had a shorter hospital stay (P=0.008). Cumulative 1-year mortality was 0% in patients with initial TIMI-3 flow, 11.3% with TIMI 0-2 flow (P=0.019). By COX regression analysis, postprocendural TIMI-3 flow was an independent determinant of survival (OR=0.285,P=0.004) , however,TIMI-3 flow before coronary intervention was not found as an independent determinant of survival significantly. The lenitive symptoms and current smoking were the independent determinants of TIMI-3 flow before coronary intervention (P=0.005, P=0.048, respectively).Conclusion: Patients undergoing primary percutaneous transluminal coronary intervention in whom TIMI-3 flow is present before angioplasty may present with greater clinical and angiographic evidence of myocardial salvage, be less likely to develop complications related to left ventricular failure, and improve early and late survival.
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<p><b>OBJECTIVE</b>To determine the association of cigarette smoking and coronary artery diseases (CAD).</p><p><b>METHODS</b>A case-control study involving 355 people classified as CAD or without CAD was performed. But people treated with diuretic, aspirin, lipid-lowering agents, heparin or those with renal, hepatic diseases were excluded. Gender, age, body mass index, plasma glucose under fasting, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fibrinogen, cigarette smoking consumption grade (0: no smoking, 1: less or equal 100 cigarette year, 2: one hundred cigarette year < cigarette index </=200 cigarettes year, 3: greater than 200 cigarette year), CAD family history, essential hypertension and CAD severity were analyzed.</p><p><b>RESULTS</b>In multiple logistic regression, age, gender, fasting plasma glucose, fibrinogen and cigarette smoking showed significant independent association with CAD. Compared with non-smoker, the odds ratio (OR) of CAD of grade 3-cigarette smoking was 3.519 (95% CI: 1.538 - 8.053, P = 0.003). However with grade 1 cigarette smoking group, no significant independent association was found with CAD (OR = 0.948, P = 0.959). With more than grade 2 [grade 2 + 3, compared with less than grade 2 (0 + 1)] and grade 3 [compared with less than grade 3 (0 + 1 + 2)] cigarette smoking, ORs of CAD were 2.094 (P = 0.027), 3.463 (P = 0.002) respectively. Three hundred fifty-five people were divided into 3 groups: control, stable angina (SA) and unstable angina (UA) groups. In multinomial logistic regression, when comparing with UA, parameter estimate of cigarette smoking degree in the SA group were beta = -0.220, s(x) = 0.138, P = 0.112, OR = 0.803 respectively.</p><p><b>CONCLUSIONS</b>Cigarette smoking was a significant independent risk factor for CAD. With more cigarettes smoked, a higher odds ratio of CAD was seen. Gender, age, fibrinogen and plasma glucose during fasting were also independent factors significantly associated with CAD. No significant independent association between cigarette smoking and unstable angina was found.</p>
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Female , Humans , Male , Middle Aged , Case-Control Studies , Coronary Artery Disease , Epidemiology , Odds Ratio , Risk Factors , SmokingABSTRACT
The reaction conditions, the spectrophotometric characteristics, and the analytical properties of the ion-association complex of 〔I2Br〕- with the basic triarylmethane dye such as ethyl violet (EV), crystal violet (CV), and victoria blue 4R (VB4R) in the presence of polyvinyl alcohol (PVA) were studied. The results showed that the color of the solutions would change obviously when the above ion-association complexes were formed in dilute phosphoric acid solution. The molar absorptivities (ε) of different systems are between 2.6×104 and 6.2×104 L*mol-1*cm-1. The sensitivity of the ethyl violet system is the highest among them. Beer′s law is obeyed in the range of 0～1.6 mg/L I- for ethyl violet system, 0～1.4 mg/L for crystal violet system, and 0～0.8 mg/L I- for victoria blue 4R system, respectively. The method can be applied to direct determination of iodide in aqueous solution. The method has good selectivity. A large amounts of halide ions, some other inorganic acid group ions and amount of common metal ions don′t interfere the determination of I-. This method was used to determine I- in kelp, laver and soy bean with satisfactory results
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Objective To evaluate the effects of intraaortic balloon pump (IABP) support in the emergency interventional procedures on pump failure or cardiogenic shock complicating acute myocardial infarction (AMI). Methods Group A included 21 patients with IABP support during the emergent interventional procedures, and group B included 66 patients without IABP. The two groups were compared for clinical criteria and in-hospital events or complications.Results No significant differences were noted between the two groups witch regard to baseline age, gender, onset of chest pain, timing of intervention, location of AMI, the number of coronary artery diseases, individual infarct-related artery, and TIMI grade before intervention. The degree of pump failure was significantly worse in group A than in group B. In a follow-up period of in-hospital, mortality and revascularization in-hospital were lower in the patients with IABP than in the patients without IABP. Conclusion The combination of early IABP and successful emergency coronary intervention is associated with improved survival in patients with pump failure or cardiogenic shock complicating AMI.
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0.05).Conclusion 64-slice CT provided a high diagnostic accuracy in assessing coronary artery stenosis.