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173 个结果
  • 简介:Coronaryarterybypassgrafting(CABG)isenteringaneweraasminimallyinvasivetechniques,off-pumpsurgeryandtotal'arterialrevascularizationhavefotmdrolesinthesurgicaltreatmentofpatientswithcoronaryarterydisease.Thecontinueddevelopmentofthetechniquesofpercutaneouscoronaryintervention(PCI)isalsohavinganimpactonthetypeofpatientreferredforCABG.

  • 标签: 冠状动脉旁路移植术 介入治疗 冠心病 外科治疗 适应症 手术风险
  • 简介:ObjectivesTounderstandtheeffectofcarvedilolonthecoronaryvascularendothelialfunctionofthepatientswithcoronaryheartdiseaseafterpercutaneoustransluminalcoronaryangioplasty(PTCA).Methods51cases,havingoneormorethantwobranchesnarrow(≥70%),werediagnosedbycoronaryangiography.Thesepatientsweredividedrandomlyintocarvedilolgroup(n=28)andcontrolgroup(n=23)whodidnottakecarvedilol.Endothelin(ET)andnitrodioxide(NO)levelsofperipheralbloodweremeasuredbeforeandafterPTCA,beforeandaftertwoweeksbytakingcarvedilol.ResuitsComparedwiththeETandNOlevelsbeforePTCA,ETweremarkedlyincreasedandNOweredecreasedafterPTCA(p<0.05);comparedwiththeETandNOlevelsbeforetakingcarvedilol,ETweredecreasedandNOwereincreasedaftertwoweek(p<0.05),buttheETandNOlevelsofthecontrolgroupdidnotchangeintheperiodoftwoweeksobservation(p>0.05).ConclusionsCarvedilolmayimprovethecoronaryvascularendothelialfunctionafterPTCA.

  • 标签: 卡维地洛 冠状动脉 血管内皮功能 经皮冠状动脉血管成形术
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  • 简介:Thereareseveraltechniquesforperformingcoronaryatheroscleroticplaquemodification,knownasatherectomy.Historically,clinicaltrialsshowmostlyequivalencebetweenvariouscoronaryatherectomytechniques,balloonangioplasty,andpercutaneouscoronarystenting.Inthelastseveralyearstheuseofagivenatherectomytechniquehasbeenmostlyasameansoffacilitatingstentdeliveryinvesselsthatareheavilycalcified.Noclinicaltrialshaveshownsuperiorityofanyatherectomymethodovermorestandardtechniquesofpercutaneouscoronaryintervention.Thisreviewbeginswithadiscussionofdirectionalatherectomy,whichisnolongeravailable.Therotationalatherectomytechniqueanditsclinicaltrialdataarepresented.Orbitalatherectomyisthendiscussedindetail,includingtherelevantclinicaltrials.Finally,laseratherectomytechniquesarereviewed,andthepertinenttrialdataarepresented.Lastly,futuredirectionsaredetailed.

  • 标签: CORONARY artery disease PERCUTANEOUS CORONARY INTERVENTION
  • 简介:Coronaryarterycalcification(CAC)isasanindependentriskpredictorofcardiovasculardiseaseandcanclassifyanindividual’sriskofatheroscleroticcardiovasculardisease,particularlyinintermediate-riskindividuals.Also,CACprogressionisassociatedwithgreaterratesofcardiovascularevents.ThisarticleprovidesavailabledataandexpertrecommendationsforCACbasedoncurrentpublications.WefocusontheutilityofCACforstratificationofindividualsanddescribeitsdiagnosticvalueinidentifyingpatientsatrisk.WealsodescribetheimportantabilityofCACtoderiskapatientwithascoreofzero.

  • 标签: CORONARY ARTERY calcifi CATION ASCVD RISK
  • 简介:Myocardialperfusioniswellcontrolledbyadjustmentofvasomotortoneofre-sistancevessels.Thestaticandsamedynamicaspectsofcoronaryflowcontrolcanwellbedescribedbyassumingfeedbackfromtissueoxygenpressuretothecoronaryvessel.Theseresistancevesselsaresmallarteriesfrom400/mandlessinarteriolesdownto10/m.Itisnotclearyethowvesselsofdifferentsizecanbeunderthecon-troloftissuefactorsandhowadaptationoftoneinlargervesselsistunedtothatofsmallerones.

  • 标签: PERFUSION ARTERIES adjustment tuned ADAPTATION metabolism
  • 简介:AbstractBackground:Imprecise interpretation of coronary angiograms was reported and resulted in inappropriate revascularization. Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a comprehensive system to evaluate the complexity of the overall lesions. We hypothesized that a real-time SYNTAX score feedback from image analysts may rectify the mis-estimation and improve revascularization appropriateness in patients with stable coronary artery disease (CAD).Methods:In this single-center, historical control study, patients with stable CAD with coronary lesion stenosis ≥50% were consecutively recruited. During the control period, SYNTAX scores were calculated by treating cardiologists. During the intervention period, SYNTAX scores were calculated by image analysts immediately after coronary angiography and were provided to cardiologists in real-time to aid decision-making. The primary outcome was revascularization deemed inappropriate by Chinese appropriate use criteria for coronary revascularization.Results:A total of 3245 patients were enrolled and assigned to the control group (08/2016-03/2017, n = 1525) or the intervention group (03/2017-09/2017, n= 1720). For SYNTAX score tertiles, 17.9% patients were overestimated and 4.3% were underestimated by cardiologists in the control group. After adjustment, inappropriate revascularization significantly decreased in the intervention group compared with the control group (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.73-0.95; P = 0.007). Both inappropriate percutaneous coronary intervention (adjusted OR: 0.82; 95% CI: 0.74-0.92; P < 0.001) and percutaneous coronary intervention utilization (adjusted OR: 0.88; 95% CI: 0.79-0.98; P = 0.016) decreased significantly in the intervention group. There was no significant difference in 1-year adverse cardiac events between the control group and the intervention group.Conclusions:Real-time SYNTAX score feedback significantly reduced inappropriate coronary revascularization in stable patients with CAD.Clinical trial registration:Nos. NCT03068858 and NCT02880605; https://www.clinicaltrials.gov.

  • 标签: Real-time SYNTAX score Coronary revascularization Appropriate use criteria Quality improvement
  • 简介:BackgroundSeveralstudieshavereportedanassociationofhyperglycemiawithincreasedmortalityandcomplicationsinhospitalpatientswithacutecoronarysyndrome(ACS).However,theinfluenceofstresshyperglycemia(SH)onthemedium-andlong-termprognosesinACSpatientshasnotyetbeendetermined.MethodsRandomvenousbloodglucoselevelsweredeterminedin433ACSpatientsandthepatientsweredividedintotwogroupsbasedonbloodglucoseresultsanddiseasehistories.The171patientsincludedintheexperimentalgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-upandhadfastingbloodglucoselevelsof≥7.0mmol/Landrandombloodglucoselevels≥11.1mmol/L.The262patientsincludedinthecontrolgrouphadnohistoryofdiabetes,hadnodiabetesand/orglucosemetabolismdisordersduringhospitalizationandfollow-up,andhadfastingbloodglucoselevels<6.1mmol/Landrandombloodglucoselevels<7.8mmol/L.Basicclinicalinformation,coronaryangiographiclesioncharacteristics,PCIsuccessrate,complicationrate,incidenceandmorbidityrateofcardiovasculareventsduringthehospitalizationperiodand6yearsoffollow-upwerecomparedbetweenthetwogroups.ResultsTherewasnosignificantdifferenceinage,genderordiseasehistorybetweenthetwogroups.Thetriglyceridelevelsandtheleftventricularejectionfractionsweresignificantlyhigher(P=0.00)andsignificantlylower(P=0.03)intheexperimentalgroupthaninthecontrolgroup,respectively.BothgroupsweresubjectedtocoronaryangiographyandPCI.ThePCIsuccessratesofthetwogroupsdidnotdiffersignificantly(P=0.63).TheexperimentalgrouphadmoretypeB2lesions,butfewertypeAlesionscomparedwiththecontrolgroup.Theexperimentalgrouphadsignificantlymorestentsimplantedcomparedwiththecontrolgroup(P<0.05).Thecardiovasculareventsweresignificantlyincreased(P=0.01)intheexperimentalgroupcomparedwiththecontrolgroup1yearafterdischarge.Thein

  • 标签: 急性冠脉综合征 冠状动脉造影 高血糖 并发症 应激性 预后
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  • 简介:ObjectivesTostudyclinicalandcoronaryangiographicfindingsinpatientswithbothcoronaryheartdiseases(CHD)andtype2diabetesmellitus(T2DM).Methods215patientswithCHDconfirmedbycoronaryangiographywereinvolvedinthisstudy.Thepatientsweredividedintotwogroups:74CHDpatientswithT2DM(meanage64.7±8.2years,male/female47/27),and141CHDpatientswithoutT2DM(meanage66.2±9.2years,male/female100/41).Theclinicalfeaturesandthedatafromselectivecoronaryangiographieswerecomparedbetweentype2diabeticandnon-diabeticCHDpatients.ResultsComparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromacutemyocardialinfarction,silentischemiaandseverearrhythmias(P<0.01,P<0.05),andhadhigherserumtriglyceridesandapo-lipoproteinB,alongwithincreasedserumuricacid(P<0.01,P<0.05),increasedleftventricularenddiastolicdiameter(P<0.01),anddecreasedleftventricularejectionfraction(P<0.001).Comparedtonon-diabeticCHDpatients,thepatientswithbothCHDandT2DMsufferedmorefromtriplevesseldisease(P<0.01),severecoronaryarterystenosis,completeocclusionsanddiffuselesions(P<0.001).ConclusionsSevereclinicalmanifestation,leftventriculardysfunction,diffuseorcomplicatedlesionsofcoronaryarteriesweremorecommoninpatientswithbothCHDandT2DM,itsuggeststhatthetype2diabeticCHDpatientshavepoorprognosis.

  • 标签: CORONARY HEART DISEASE Type 2diabetes MELLITUS
  • 简介:Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

  • 标签: CORONARY ARTERY disease CHRONIC total OCCLUSION
  • 简介:BackgroundThecoronarycollateralcirculationhasapositiveeffectontheischemicmyocardium.Butitislimitedforpatientsmissingthetimewindowoftotalocclusionofthecoronaryarteryelectivepercutaneouscoronaryintervention(PCI).Theeffectofcollateralcirculationonleftcardiacfunctionhasbeenlessstudied.MethodsAtotalof34patientswithoneormorecoronaryarteryocclusionwhounderwentcoronaryangiographyandRentrop'smethodweredividedinto2groups:Goodcollateralcirculation(Agroups,Rentropscore2-3,n=19)and(Bgroups,Rentropscore1-2,n=15).Theimprovementofleftventricularenddiastolicvolume(LVEDV)andleftventricularejectionfraction(LVEF)werecomparedbetweenthetwogroupsbeforeandafterPCI.ResultsIngoodcollateralcirculationgroup,leftventricularejectionfraction(LVEF)wassignificantlyhigherafterPCI(P<0.05).Inpoorcollateralcirculationgroup,leftventricularenddiastolicvolumeindex(LVEDV)wassignificantlyincreasedafterPCI(P<0.05).ConclusionsGoodcollateralcirculationhasasignificantprotectiveeffectonleftventricularfunction.PCIoperationcansignificantlyimprovetheprognosisofpatientswithgoodcollateralcirculationofcoronaryarteryocclusion.

  • 标签: 冠状动脉造影 循环 患者 价值 预测 时间窗口
  • 简介:ObjectivesTocomparethedifferentpatternsofcoronaryarterycalcification(CAC)inacuteandchroniccoronarysyndromesutilizingelectronbeamcomputedtomography.BackgroundPathologic,angiographic,andintracoronaryultrasoundstudiesrevealedsharpdifferencesintheplaquemorphologybetweenpatientswithacuteversuschroniccoronarysyndromes.Whethertherearedifferentpatternsofcoronaryarterycalcificationinpatientswithstableanginapectoris(SAP)andinthosewithunstableanginapectoris(UAP)oracutemyocardialinfarction(AMI),however,remainsunclear.MethodsTwohundredandsixty-fourpatients,including67withSAP,94withUAPand103withAMIwerestudiedwithelectronbeamcomputedtomographyforanalysisofcoronaryarterycalcificationandwithselectivecoronaryangiographyfordeterminationofatheroscleroticlesions.CACprevalenceandcalciumscorewerecomparedamongthreegroups,andrelationofCACtotheseverityofatheroscleroticdiseaseintheSAPandUAP

  • 标签: CORONARY ARTERY disease Calci-fication Tomography/X -
  • 简介:ObjectivesToevaluatethesafetyandefficacyoftransradialcoronaryprocedures(TRCP).MethodsThedataof83caseswhoacceptedtransradialcoronaryangiography(CAG)andtransradialpercutaneouscoronaryintervention(PCI)inourdepartmentweresummarized.Thesuccessrates,proximalcoronarycomplications,peripheralvascularcomplications,severevagalreflex,meanoperationtime(MOT),meanrecumbenttime(MRT),meanhospital-stayingtime(MHT)wereanalyzed.Thedatawerecomparedwiththatof420casesoftransfemoralcoronaryprocedures(TFCP)inthesameperiod.ResultsSuccessratesandproximalcoronarycomplicationsweresimilarinbothgroups.SeverevagalreflexeswerelessinTRCPgroupthaninTFCPgroup.MOTwaslongerinTRCPgroup.MRTandMHTwereshorterinTRCPgroup.12(14.5%)radialarteryspasm,3(3.6%)radialarteryobstruction,1suddenrespiratoryarrestcausedbyjugularhematomawereobservedinTRCPgroup.ConclusionsTheefficacyandsafetyofTRCParedefinite.TRCPismoreeconomical.ForthepurposeofproperlyevaluatetheperipheralvascularcomplicationsofTRCP,itisnecessarytopayspecialattentiontoradialarteryocclusion,radialarterystenosis,andjugularhematoma.

  • 标签: 冠状血管疾病 血管照影技术 病理机制 治疗
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