Background: Mechanical circulatory support may facilitate high-risk percutaneous coronary intervention (PCI). This study aimed to assess the feasibility, safety and effectiveness of high-risk PCI under the support of venoarterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pump (IABP). Methods: We enrolled patients who received VA-ECMO plus IABP-assisted PCI procedures at our center from April 2012 to June 2018. Major adverse cardiac events (MACEs) included all-cause death, myocardial infarction, and target vessel revascularization. Results: A total of 10 patients were included, with a mean age of 71 years, EuroSCORE II of 19.9%, and SYNTAX score of 39.8. Procedural success was achieved in nine (90%) patients. The mean duration of ECMO support was 1.5 hours, and 2.6 stents were implanted per patient. Major complications included contrast-induced nephropathy needing hemodialysis in one (10%) patient, significant hemoglobin drop requiring blood transfusion in two (20%) patients, pulmonary infection in one (10%) patient, and local surgical incision infection in one (10%) patient. The accumulative mortality rates for the nine patients with procedural success were 0, 22.2%, and 44.4% at 1, 3, and 5 years follow-up, respectively. However, cardiac death occurred in only one (11.1%) patient. In addition, two patients received repeat PCI or coronary artery bypass grafting within two years following the index procedure. The overall incidence rates of MACEs were 11.1%, 44.4%, and 66.7% at 1, 3, and 5 years follow-up, respectively. Conclusions: VA-ECMO plus IABP-assisted high-risk PCI was feasible in patients with complex coronary disease, with a high procedural success rate and acceptable mid-term clinical outcomes.

The safety and effectiveness of remote guidance of percutaneous coronary interventions (PCI) have not been fully appraised in controlled studies. We hereby presented the results of a study on remote guidance (vs on-site guidance) of PCI to explore its feasibility, safety, and effectiveness. Patients were recruited from those who received PCI procedures from January 2018 to June 2019 in a secondary hospital (Jincheng, Shanxi, China), in collaboration with a tertiary medical center (Beijing, China) approximately 680 km away. According to the type of guidance during the procedure, the patients were assigned to two groups: the remote guidance group and the on-site guidance group. Remote guidance was assisted with an advanced commercial telemedicine system. Interventional strategies, procedural success rate, peri-procedural complications, procedural duration, radiation doses, and the amount of contrast medium were compared between the two groups. A total of 352 patients were included in this study, with a total of 411 PCI procedures and 446 target lesions. The baseline clinical characteristics, as well as the distribution and characteristics of coronary artery lesions, did not differ significantly between the two groups. No significant differences were noticed in procedural success rate, peri-procedural complications, procedural duration, radiation dose, and in-hospital major adverse cardiovascular events. However, the amount of contrast medium was slightly higher in the remote guidance group. The results of the present pilot study showed the feasibility of remotely guided PCI, with safety and effectiveness measures at acceptable levels comparable to the traditional on-site guidance. Randomized studies with long-term follow-up are warranted to further confirm our findings.

目的 观察体外膜氧合器(ECMO)辅助下经皮冠状动脉介入治疗(PCI)用于高危复杂冠心病(CHD)的价值.方法 回顾性分析48例接受ECMO辅助下PCI的高危复杂CHD患者,收集其临床资料、ECMO辅助情况、PCI情况、住院期间病情变化及随访资料,观察ECMO辅助下PCI治疗高危复杂CHD的价值.结果 ECMO辅助时间0.50～3.55 h,平均(1.57±0.65)h;对46例成功完成PCI,2例因导丝、球囊通过困难而转至心脏外科行冠状动脉旁路移植术(CABG)治疗.46例PCI成功患者中,术后肺部感染4例,脑梗死2例,输血治疗2例,支架内急性血栓形成1例,切口感染1例,腹股沟血肿1例,急性心肌梗死1例.其中4例院内死亡,包括1例术后24 h内支架内急性血栓形成、1例术后第10日急性心肌梗死导致心源性休克、2例术后1周肺部感染并发感染性休克,42例出院.随访过程中2例失访,共对40例随访35.5(6,72)个月,期间5例死于其他疾患,35例病情获得改善.结论 ECMO辅助下PCI治疗高危复杂CHD安全、可行.

The aim of this study was to evaluate the effectiveness and safety of AngioJet rheolytic thrombectomy among patients with high thrombus burden. Routine manual thrombus aspiration in patients with ST-segment elevation myocardial infarction (STEMI) does not improve clinical outcomes and was associated with an increased rate of stroke. However, the safety of mechanical thrombus aspiration is still unknown. This was a retrospective, single-center study involving 621 patients with Thrombolysis In Myocardial Infarction thrombus grade 5. The primary outcome was the composite of major adverse cardiovascular events (MACE) within 12 months. The safety outcome was stroke within 1-year. Propensity matching score was calculated due to the significant baseline differences between the AngioJet rhelytic thrombectomy group and the routine treatment group. AngioJet rheolytic thrombectomy was performed in 117 patients. After propensity-score matching, there was no significant difference both in the incidence of MACE (11.1% vs 17.9%, hazard ratio, 1.641; 95% confidence interval [CI] 0.822 to 3.277, p = 0.161) and the incidences of stroke (1.7% vs 2.6%, hazard ratio 1.522; 95% confidence interval [CI] 0.254 to 9.107, p = 0.646) between two groups at 1-year follow-up. In patients with Thrombolysis In Myocardial Infarction thrombus grade 5, AngioJet rheolytic thrombectomy did not improve clinical outcomes at 1 year. However, AngioJet rheolytic thrombectomy did not increase the risk of stroke in patients with high thrombus burden.

目的 探讨甘油三酯葡萄糖乘积(triglyceride-glucose,TyG)指数对老年急性ST段抬高型心肌梗死(ST-seg-ment elevation myocardial infarction,STEMI)预后的评估价值.方法 连续选取2015年1月～2019年4月在解放军总医院第六医学中心心内科住院的老年STEMI患者515例,按TyG指数的均数将患者分为高TyG指数组(≥8.69)259例和低TyG指数组(<8.69)256例,均随访12个月,记录2组主要不良心脑血管事件(major adverse cardiovascular and cerebral events,MACCE),采用Kaplan-Meier生存曲线分析,用多因素logistic回归分析.结果 高TyG指数组MACCE发生率显著高于低TyG指数组(35.9％vs 24.2％,P=0.004),平均生存时间显著低于低TyG指数组(282.7 d vs 319.9 d,P=0.001).logistic回归分析显示,首次心功能分级(Killip分级≥Ⅱ级)、估算的肾小球滤过率、未接受血运重建、主动脉内球囊反搏、年龄、TyG指数、既往心房颤动是老年STEMI患者MACCE的独立影响因素(P<0.05,P<0.01).结论 老年STEMI患者中,较高的TyG指数水平与MACCE风险增加相关,TyG指数可能是老年STEMI患者临床结局的有效预测指标.

BACKGROUND Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers hemodynamic support for patients undergoing high-risk percutaneous coronary interventions (PCIs). However, long-term outcomes associated with VA-ECMO have not previously been studied. AIM To explore long-term outcomes in high-risk cases undergoing PCI supported by VA-ECMO. METHODS In the present observational cohort study, 61 patients who received VA-ECMO-supported high-risk PCI between April 2012 and January 2020 at the Sixth Medical Center of Chinese People’s Liberation Army General Hospital were enrolled. The endpoint characteristics such as all-cause mortality, repeated cardiovascular diseases, and cardiac death were examined. RESULTS Among 61 patients, three failed stent implantation due to chronic total occlusions with severely calcified lesions. One patient showed VA-ECMO intolerance because of high left ventricular afterload. PCI was successfully performed in 57 patients (93.4%). The in-hospital mortality was 23.0%, and the overall survival was 45.9%, with a median follow-up period of 38.6 (8.6-62.1) mo. CONCLUSION VA-ECMO can be used as a support in patients undergoing high-risk PCI as it is associated with favorable long-term patient survival.

目的:观察体外膜肺氧合(ECMO)辅助治疗高危急性心肌梗死的效果.方法:选择某医院接受ECMO辅助治疗的高危急性心肌梗死27例,根据ECMO置入时机分为经皮冠状动脉介入治疗(PCI)术前组17例和PCI术后组10例.收集入选病例的基本情况,比较两组冠状动脉病变特点、PCI治疗情况、ECMO辅助治疗时间、术后并发症发生情况及患者预后.结果:所有病例均顺利完成PCI治疗,术中无一例病死.所有病例均有一支以上冠状动脉完全闭塞,两组左主干(LM)、左前降支(LAD)、左回旋支(LCX)及右冠状动脉(RCA)闭塞严重程度差异不显著(P＞0.05);PCI术后组LM闭塞占比显著高于PCI术前组(P＜0.05),两组LAD、LCX、RCA闭塞占比以及双支血管闭塞、三支血管闭塞占比均差异不显著(P＞0.05);PCI术前组重度钙化比例显著高于PCI术后组(P＜0.05),Syntax积分显著高于PCI术后组(P＜0.05).两组支架植入数量及造影剂剂量差异不显著(P＞0.05).PCI术前组ECMO治疗时间非常显著短于PCI术后组(P＜0.01);两组辅助治疗方式仅采用ECMO或ECMO联合主动脉内球囊反搏(IABP)占比差异不显著(P＞0.05);PCI术后组机械性溶血症发生率及院内死亡发生率显著高于PCI术前组(P＜0.05),两组血栓栓塞、感染发生率差异不显著(P＞0.05).PCI术前组院内死亡3例中,因心源性休克死亡2例,因PCI术后支架内急性血栓形成死亡1例;PCI术后组院内死亡7例均因心源性休克死亡.结论:ECMO辅助在保障PCI术中安全效果较好,对心源性休克的救治有一定效果,但并非终极手段.

目的 评价PCI对于老年无保护左主干病变合并心力衰竭(心衰)患者的临床疗效和远期预后.方法 选择2016年1月～2019年1月解放军总医院第六医学中心心内科行PCI的老年无保护左主干病变冠心病患者99例,依据术前LVEF分为心衰组44例(LVEF≤50％),心功能正常组55例(LVEF＞50％).收集2组住院各项指标、PCI情况及随访1年结果,分析PCI对患者疗效和远期预后.结果 心衰组高血压、左主干+3支病变、SYNTAX评分、支架总长度明显高于心功能正常组[56.8％vs 34.5％,P＜0.05;43.2％vs 23.6％,P＜0.05;(30.43±5.22)分 vs(26.37±4.91)分,P＜0.01;(41.33±15.35)mm vs(32.86±17.81)mm,P＜0.05].心衰组术后 1 年全因病死率明显高于心功能正常组,有统计学差异(P＜0.05).心衰组术后1年LVEF明显高于术前[(44.83±10.94)％vs(38.35±11.38)％,P＜0.05],B型钠尿肽水平明显低于术前[(1375.76±534.43)ng/L vs(2835.35±898.78)ng/L,P＜0.05].结论 内科PCI可以在患者不愿或不能耐受冠状动脉旁路移植术情况下,作为老年无保护左主干病变合并心衰患者再血管化的一项重要手段.

目的 探讨胸主动脉腔内修复术(TEVAR)后持续疼痛对B型主动脉夹层患者中长期预后的影响.方法 回顾性分析2012年1月至2016年12月解放军总医院第六医学中心连续收治并进行TEVAR的B型主动脉夹层患者的临床资料32例,并进行随访.按照术后是否出现疼痛分为疼痛组和非疼痛组.结果 30例患者完成了平均5.25年随访,疼痛组13例,非疼痛组17例.两组患者的性别、年龄、合并疾病、住院天数、住院费用及发病至手术间隔时间比较,差异均无统计学意义(均P>0.05).疼痛组手术所用时间短于非疼痛组[(83.46±10.37)min比(92.59±9.36)min,P=0.017],支架平均直径大于非疼痛组[(37.62±3.93)mm比(33.35±2.50)mm,P=0.001],差异均有统计学意义.疼痛组患者支架平均长度虽较非疼痛组偏长,但差异无统计学意义[(183.38±31.25)mm比(172.00±28.10)mm,P=0.304].疼痛组死亡1例,再发夹层1例;非疼痛组死亡2例,再发夹层1例,再次介入治疗1例.疼痛组与非疼痛组患者复合终点事件发生率比较,差异无统计学意义[2(2/13)比4(4/17),P=0.655].结论 尚无法得出TEVAR术后持续疼痛对B型主动脉夹层长期预后是否产生不利影响.

目的 分析年龄≥60岁女性左主干病变血运重建患者5年生存情况.方法 收集解放军总医院第六医学中心2013年1月～2015年12月收治的年龄≥60岁连续女性左主干病变患者46例,根据血运重建方法分为PCI组14例和冠状动脉旁路移植术(CABG)组32例,收集入选者一般临床资料,观察主要不良心血管事件(MACE)发生情况.结果 PCI组2例死亡,1例因脑梗死卧床,3例偶有心悸、胸闷,口服药物好转,不影响日常生活.CABG组2例失访,3例随访到2018年,3例术后院内死亡,1例随访期间乳腺癌死亡,1例术后5年行PCI.PCI组与CABG组MACE发生率及生存时间比较,无统计学差异[21.4％ vs 20.0％,P=0.955;(75.3±3.1)个月vs (81.2±5.5)个月,P=0.974].结论 对于左主干病变患者,CABG仍是首选的血运重建方式,对于经过选择的老年女性左主干病变患者,PCI是一种可接受的血运重建方式.

目的 观察体外膜肺氧合(ECMO)辅助在年龄≥75岁的高危冠心病患者PCI中的应用效果.方法 回顾性分析解放军总医院第六医学中心心内科ECMO辅助PCI的年龄≥75岁的高危冠心病患者25例临床资料,包括基本情况、冠状动脉病变特点、PCI经过、ECMO辅助过程、术后合并症、并发症和预后.结果 在25例高危冠心病患者中,单纯ECMO辅助20例(80％),主动脉内球囊反搏+ECMO辅助5例(20％),ECMO辅助(1.43±0.51)h,术后脑梗死2例(8％),切口感染1例(4％),腹股沟血肿1例(4％),合并肺部感染4例(16％),输血治疗2例(8％).成功完成支架置入23例(92％),置入支架(2.64±1.19)枚,造影剂用量(137.28±75.61)ml.术中无死亡病例,院内死亡4例(16％).平均随访(37.55±6.68)个月,随访期间死亡3例(12％).结论 及时、合理的ECMO辅助有助于保障年龄≥75岁的高危冠心病PCI的安全,但需做好并发症预防和处理,以改善患者预后.

目的 评价体外膜肺氧合(ECMO)应用于老年女性复杂高危冠心病患者PCI的有效性和安全性.方法 选择2012年5月～2020年5月在解放军总医院第六医学中心心内科用ECMO辅助行PCI的老年女性复杂高危冠心病患者12例,回顾性分析患者的冠状动脉病变特点、ECMO辅助时间、PCI情况、围术期并发症、治疗效果及随访结果等.结果 12例患者中,10例(83.3％)单纯应用ECMO辅助,2例(16.7％)应用主动脉内球囊反搏联合ECMO辅助,ECMO辅助时间(1.53±0.55)h,术后脑梗死1例(8.3％),切口感染1例(8.3％),合并肺部感染1例(8.3％),术中无死亡患者,治疗后,好转或治愈出院11例(91.7％),院内死亡1例(8.3％).结论 ECMO循环辅助对老年女性高危冠心病患者行PCI提供了有效保障.

BACKGROUND Venous thromboembolism is a common vascular syndrome presenting as deep vein thrombosis and/or pulmonary embolism. Thrombus has the possibility of migrating into the left circulation via patent foramen ovale in certain extreme circumstances. Thrombus straddling a patent foramen ovale is a direct evidence of this scenario. However, the confirmed cases of thrombus in transit are still rare. CASE SUMMARY A 32-year-old man suffered from recurrent syncope and intermittent dyspnea for 1 wk. Transthoracic echocardiography confirmed a thrombus straddling the patent foramen ovale, and thrombi were also found in the bilateral pulmonary artery by computed tomography. The man underwent inferior vena cava filter placement and thrombolysis with alteplase. Echocardiography showed the absence of thrombi in both the right atrium and left atrium 2 d after hospitalization. The man was discharged to home on warfarin without any complications 2 wk later. CONCLUSION Scrutinizing intracardiac thrombi provides measurable value in pulmonary embolism as closure of patent foramen ovale may be considered in certain patients. Early intervention plays a critical role in thrombus straddling a patent foramen ovale. A sedentary lifestyle may predispose young adults to thromboembolism, even if there are no other risk factors.

目的 比较国产雷帕霉素与依维莫司或佐他莫司药物洗脱支架治疗冠状动脉左主干开口及体部病变的效果.方法 选取本院2014年5月～2015年12月收治的44例冠状动脉左主干开口及体部病变行药物洗脱支架介入治疗的患者作为研究对象,按支架的类型分为国产雷帕霉素药物洗脱支架组(雷帕霉素支架组,FIREWARK、NANO)16例和依维莫司或佐他莫司药物洗脱支架组(依维莫司、佐他莫司支架组,Promus element、Xince V、Resolute)28例并随访观察.对比两组的心因性死亡(无明确的其他原因的死亡)情况,靶血管血运重建的事件发生率.结果 所有患者平均随访33个月,雷帕霉素支架组的事件发生率为6.25％,依维莫司、佐他莫司支架组的事件发生率为7.14％,两组的事件发生率比较,差异无统计学意义(x2=0.01,P=0.922).结论 国产雷帕霉素药物洗脱支架治疗左主干开口及体部病变的效果不劣于依维莫司或佐他莫司药物洗脱支架.

目的 探讨西藏不同海拔高度地区生活的儿童,先天性心脏病患病率及患病种类的差别.方法 选择2012年10月至2016年10月在西藏自治区不同海拔地区进行先心病筛查的年龄在3～17岁的12878例藏族儿童,根据居住地海拔不同分为3组:L组、H组、VH组.由临床医生进行体格检查和听诊筛选出疑似病例,再由心脏专科医生进行全面超声心动图检查确诊,最后将患病数据进行统计分析.结果 随着海拔的升高,先心病的患病率从4.37/1000升高至13.35/1000;女性与男性患病率的比值从1.3升高至3.1.其中,PDA的患病率升高7倍,ASD的患病率升高1.5倍,ASD是海拔<4200 m最常见的先天性心脏病(56.3％),而PDA是海拔>4200 m最常见的先心病(60.9％).结论 显示西藏地区先心病的患病率因海拔的不同而存在很大差异(4.37/1000～13.35/1000).而且提示ASD是海拔<4200 m最常见的先心病,而PDA是>4200 m最主要的先心病类型.随着海拔的升高,女性患病率的升高更加显著.

BACKGROUND:To analyze the cardio-protective effects of ticagrelor in patients with acute coronary syndrome with S-T segment elevation.METHODS:The sample was 200 patients who had been diagnosed with acute coronary syndrome accompanied by diabetes Mellitus type II. Only patients having ST segment elevation before the treatment were included. Then, the subjects were further randomly divided into an observation group and a control group. The control group of 100 patients received clopidogrel; the observation group of 100 patients of ticagrelor. The serous creatine kinase CK-MB, functional cardiac indexes of left ventricular end diastolic diameter (LVDD), cardiac troponin I, ventricular ejection fraction, and relevant major adverse cardiovascular events (MACE) were compared between the two groups.RESULTS:One month after a percutaneous coronary intervention (PCI) the observation group showed better results against angina, stent thrombosis, and all-cause mortality compared with those of the control subjects. Six months after treatment, both groups suffered adverse reactions. The number of patients who suffered adverse reactions in respiratory tract in the observation group was higher than in the control group. The inhibition of platelet aggregation IPA of ticagrelor was found to be significantly higher than clopidogrel, having a significant p value.CONCLUSION:Ticagrelor can effectively protect myocardial function for patients with ST-segment elevation acute coronary syndrome accompanied by diabetes and can reduce the incidence of adverse reactions..

目的探讨体外膜肺氧合（ECMO）联合主动脉内球囊反搏（IABP）预防性应用于高危经皮冠状动脉介入治疗（HR-PCI）患者的短期临床疗效。方法选择2018年5–8月10例HRPCI患者,术中应用ECMO联合IABP循环支持。结果 10例患者中男性8例,女性2例,年龄51～84（70.3±11.1）岁,平均左心室射血分数（35.7±10.2）%。10例患者均为严重三支病变,左主干病变7例,其中合并右冠状动脉（RCA）慢性完全闭塞（CTO）病变5例,前降支CTO病变2例;剩余3例中2例为RCA和左前降支（LAD）近/中段CTO病变,1例为RCA CTO病变合并LAD/左回旋支（LCX）严重狭窄。在ECMO联合IABP支持下7例左主干病变中先处理左主干病变6例,1例处理了RAC CTO病变和LAD重度狭窄;剩余3例中2例RCA和LAD近/中段CTO病变均先处理了LAD CTO病变,另1例RCA CTO病变合并LAD/LCX严重病变患者先处理了RCA CTO病变。术中ECMO平均灌注流量（1.80±0.30）L/min,总运转时间（3.4±0.7）h。PCI平均手术时间（2.2±0.5）h。1例PCI术中发生血流动力学崩溃,ECMO灌注流量提高到3.0 L/min维持血流动力学,直到循环正常。术后所有患者ECMO均成功撤机。2例患者IABP穿刺部位血肿,其中1例术后发现假性动脉瘤;1例术后于ICU发生室性心动过速和心室颤动;无ECMO管道机械性问题、下肢缺血和感染并发症发生。结论对不适合行外科血管重建术的HR-PCI术患者,ECMO联合IABP循环支持下行PCI术是可行的。

Objective To assess the feasibility,safety and efficacy of primary PCI in elderly patients with AMI.Methods Three hundred and sixty-four AMI patients were divided into ≥75 years old group (n=90) and ＜75 years old group (n=274).The successful operation rate,preoperative complication rate,mortality and incidence of major adverse cardiovascular events (MACE) were recorded during their hospital stay time.Results The successful operation rate was 94.4％,the postoperative TIMI 3 blood flow rate was 87.8％,and the preoperative complication rate was 10.0 ％ in ≥75 years old group.The mortality and incidence of MACE were significantly higher in ≥75 years old group than in＜75 years old group during the hospital stay time (12.2％ vs 2.9％,P =0.001;16.7 ％ vs 5.1％,P =0.000).Conclusion Transradial primary PCI is a safe,feasible and effective therapy for ≥75 years old AMI patients.