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.

简介：BackgroundManypatientshavesymptomssuggestiveofcoronaryarterydisease(CAD)andareoftenevaluatedwiththeuseofdiagnostictesting,althoughtherearelimiteddatafromrandomizedtrialstoguidecare.MethodsWerandomlyassigned10,003symptomaticpatientstoastrategyofinitialanatomicaltestingwiththeuseofcoronarycomputedtomographicangiography(CTA)ortofunctionaltesting(exerciseelectrocardiography,nuclearstresstesting,orstressechocardiography).Thecompositeprimaryendpointwasdeath,myocardialinfarction,hospitalizationforunstableangina,ormajorproceduralcomplication.SecondaryendpointsincludedinvasivecardiaccatheterizationthatdidnotshowobstructiveCADandradiationexposure.ResultsThemeanageofthepatientswas60.8±8.3years,52.7%werewomen,and87.7%hadchestpainordyspneaonexertion.ThemeanpretestlikelihoodofobstructiveCADwas53.3±21.4%.Overamedianfollow-upperiodof25months,aprimaryend-pointeventoccurredin164of4996patientsintheCTAgroup(3.3%)andin151of5007(3.0%)inthefunctional-testinggroup(adjustedhazardratio,1.04;95%confidenceinterval,0.83to1.29;P=0.75).CTAwasassociatedwithfewercatheterizationsshowingnoobstructiveCADthanwasfunctionaltesting(3.4%vs.4.3%,P=0.02),althoughmorepatientsintheCTAgroupunderwentcatheterizationwithin90daysafterrandomization(12.2%vs.8.1%).ThemediancumulativeradiationexposureperpatientwaslowerintheCTAgroupthaninthefunctional-testinggroup(10.0mSvvs.11.3mSv),but32.6%ofthepatientsinthefunctional-testinggrouphadnoexposure,sotheoverallexposurewashigherintheCTAgroup(mean,12.0mSvvs.10.1mSv;P<0.001).ConclusionsInsymptomaticpatientswithsuspectedCADwhorequirednoninvasivetesting,astrategyofinitialCTA,ascomparedwithfunctionaltesting,didnotimproveclinicaloutcomesoveramedianfollow-upof2years.

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简介：BackgroundPreviousstudieshaveimplicatedastronglinkbetweencirculatingplasmaresistinandcoronaryarterydisease(CAD).Theaimofthisstudywastoinvestigatewhetherresistinelevationpredictsworseoutcomeofstent-placementinacutecoronarysyndrome(ACS)patients.MethodsTotally126ACSparticipantswhowereeligibleforstent-placementwereenrolledfor2years'follow-upbymonitoringclinicalendpointsoccurringviaoutpatientvisitsor/andtelephonecall.Baselinecharacteristicswerecollected.Allparticipantsweredividedintolowresistingroup(<3.464μg/mL)andhighresistingroup(>3.464μg/mL).Clinicalendpointsintermsofmajoradversecardiovascularevents(MACE),cardiovasculardeath,non-fatalmyocardialinfarction,ischemicstroke,andcoronaryrevascularization(CR)werecompared.ResultsPatientswithstenosisinthreevesselspresentedmorefrequentlyinhighresistingroupthaninlowresistingroup(35.6%vs.48.3%,P=0.001).IncidencesofMACEandCRweresignificantlyhigherinhighresistingroupthanthoseinlowresistingroup(31.6%vs.18.8%,P=0.018);15%vs.7.58%,P=0.006).ConclusionsInpatientswithbaselineresistinelevation,theincidenceofMACEissignificantlyincreasedafterstent-placement.

简介：Pheochromocytomaisatumorarisingfromneuroectodermalchromaffintissuesintheadrenalglandorextra-adrenalparaganglia(paragangliomas).Theprevalenceofthetumoris0.1%-0.6%inthehypertensivepopulation,ofwhich10%-20%aremalignant.Pheochromocytomaproduces,stores,andsecretescatecholamines,aswellasleadstohypertensivecrisis,arrhythmia,angina,andacutemyocardialinfarctionwithoutcoronaryarterydiseases.Wereportacaseofacutecoronarysyndrome(ACS)withafinaldiagnosisofmultipleendocrineneoplasiawithpheochromocytomaandmedullarythyroidcarcinoma(MTC).

简介：‘Stent对stent’研究是被设计与以前同意的相比显示出新stent图案的优势的一种使随机化的试用。这些研究被规章的机构通常使用，例如美国食物药品管理局(食物及药品管理局)，到表示同意到新stent图案。有这些临床的试用的问题是他们的高费用和困难。在这份报纸，为‘stent对stent’的一种数字选择复杂临床的研究被介绍。一个有限元素模型被开发在冠的stent放置以后在结果上调查stent设计的影响。二商业地可得到的stents(NIR和多连接stents)被建模，他们的行为以压力分发在推广期间被比较，光线的获得，外部直径变化并且节略。而且，狭窄率上的stent设计的效果被在动脉以内比较压力分发调查。在stented动脉的动脉的墙压力的分析显示多连接stent设计原因与slotted试管NIR设计相比与局部性的stenotic损害降低应力到一个动脉粥样硬化患者容器。有观察临床的狭窄的调查结果相互关联与多连接stent设计相比在NIR评估狭窄率，它更高报导了。