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.

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..