Objective: This retrospective cohort study aimed to evaluate the effect of post-dilation on coronary blood flow and MACE events during hospitalization and 1 year follow-up following primary PCI in patients with ST-segment. Methods: 419 eligible patients who underwent PPCI due to STEMI between January 2015 and October 2019 were enrolled. The CTFC, final QCA, and the incidence of no-reflow/slow-flow during different procedure moments were assayed. Study end points was to compare two groups of patients with clinical characteristics, compared two groups of patients with the incidence of no-reflow and slow-flow, and the incidence of MACE during hospitalization and 1-year follow-up. Results: The incidence of final no-reflow/slow-flow in the post-dilation group was not significantly higher than that in the non-post-dilation group (24.3％ vs.19.4％; p = 0.238).There was no significant statistical difference in MACE events during hospitalization, but for the 1-year follow-up, the incidence of Target vessel revascularization and Target lesion revascularization in the post-dilation group was lower than that in the non-post-dilation group. A multivariable logistic regression model revealed that age (OR=1.078, 95％CI=1.038-1.120; P <0.001), history of diabetes (OR=3.009, 95％CI=1.183-7.654; P =0.021), post-dilation (OR=0.192, 95％CI=0.067-0.549; P=0.002) were independently correlated with long-term follow-up of MACE.Conclusion: Post-dilation does not increase poor prognosis during hospitalization, and reduces the incidence of TVR and TLR events during long-term follow-up.

目的 评价切割球囊联合药物涂层球囊在冠脉原发病变中的应用效果.方法 选择2017年8月11日～2020年6月11日行冠脉造影并拟行单纯药物涂层球囊治疗的冠脉原发病变患者,共91例.根据预处理方式的不同,将使用非顺应性或半顺应性球囊预处理的作为对照组(n=54),使用切割球囊预处理的作为观察组(n =37),比较两组在术中的预处理成功率.经过术后6个月的随访,比较两组患者的靶病变再狭窄、主要不良心血管事件发生率.结果 对照组的54例患者术中40例预处理成功,观察组37例患者术中36例预处理成功,两组差异具有统计学意义(P＜0.05).与对照组相比,观察组靶血管前降支和其他分支比例较高,回旋支、右冠比例较低,差异具有统计学意义(P＜0.05).对照组的54例患者中38例接受单纯药物涂层球囊治疗.观察组的37例患者中32例接受单纯药物涂层球囊治疗.与对照组比较,观察组预处理成功率较高,差异具有统计学意义(P＜0.05).预处理方式不同对预处理效果的影响具有统计学差异.非(不使用)切割球囊是预处理失败的独立危险因素.经过术后6个月随访,观察组中原靶病变再狭窄0例,非原靶病变血运重建1例.对照组中原靶病变再狭窄3例,非原靶病变血运重建2例,两组对比差异无统计学意义.结论 切割球囊完成冠脉原发病变预处理是一种非常良好的的病变准备手段,联合单纯药物涂层球囊后,获得了极低的靶血管失败率和良好的随访效果.

目的:探讨冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床特征、冠状动脉(冠脉)病变特点及危险因素.方法:回顾性分析2016年1月-2017年12月于上海交通大学医学院附属第九人民医院住院的AMI患者共476例,根据冠脉造影的结果分为MINOCA组(56例)和MICAD组(420例).比较2组患者的临床特点、心脏结构、冠脉病变特征、危险因素等.结果:与MICAD组患者比较,MINOCA组患者的年龄较大(P＜0.05)、男性较少(P＜0.05),吸烟患者较少(P＜0.05),非ST段抬高急性心肌梗死比例较低(P＜0.05);空腹血糖、肌酸激酶、肌钙蛋白、白细胞计数、谷草转氨酶值、LDL-C值更低(P＜0.05);β受体阻滞剂、他汀类药物的应用比例更低(P＜0.05).MINOCA组患者的多支病变比例显著低于MICAD组(P＜0.05).在心脏结构方面,MINOCA组和MICAD组差异无统计学意义.多因素logistic回归分析结果表明,吸烟和糖尿病是MINOCA的相关危险因素(P＜0.05).结论:与MICAD患者相比,MINOCA年龄偏大,女性较多,肌钙蛋白、LDL-C及白细胞计数明显更低.MINOCA的相关危险因素主要为糖尿病和吸烟.

目的 在冠心病患者中应用光学相干断层成像(OCT)评估分层斑块并探讨其与冠状动脉易损性的关系.方法 入选2017年6月至2020年12月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病的患者222例.入院后行冠状动脉造影,并对靶血管行OCT检查.记录患者的一般资料、既往病史、心血管用药史、临床生化指标以及OCT数据.结果 共入选222例冠心病患者,OCT提示109例(49.1％)靶血管见分层斑块,其中左前降支61例(56.0％)、左回旋支20例(18.3％)、右冠状动脉28例(25.7％).心肌梗死患者中分层斑块占比65.0％(39/60),不稳定型心绞痛患者中分层斑块占比44.6％(25/56),稳定型心绞痛患者中分层斑块占比42.5％(45/106).两组患者生化指标比较,分层斑块组小而密低密度脂蛋白胆固醇[(1.16±0.38)mmol/L比(0.99±0.45)mmol/L]、肌钙蛋白[(2.69±11.57)ng/ml比(1.18±9.06)ng/ml]均高于非分层斑块组,差异均有统计学意义(均P<0.05).靶血管OCT特征方面,与非分层斑块组比较,分层斑块组最小管腔面积更小[(2.37±1.31)mm2比(3.35±2.23)mm2]、面积狭窄率更大[(69.11±12.26)％比(59.41±17.12)％]、病变长度更长[(20.05±8.94)mm比(17.03±7.75)mm]、脂质斑块弧度更大[(250.33±88.02)°比(181.55±115.71)°]、脂质斑块更长[(17.13±8.78)mm比(11.28±8.52)mm]、纤维帽更薄[(49.04±19.32)μm比(61.21±9.12)μm],差异均有统计学意义(均P<0.05).分层斑块组血栓形成、斑块破裂、巨噬细胞、微血管化、胆固醇结晶、内膜溃疡、内膜夹层、钙化斑块、薄纤维帽脂质斑块例数均较非分层斑块组更多,差异均有统计学意义(均P<0.05).受试者工作特征曲线显示,脂质斑块弧度预测分层斑块的曲线下面积(AUC)为0.683,敏感度为87.2％,特异度为43.4％,诊断临界值为167°(P<0.001);脂质斑块长度预测分层斑块的AUC为0.688,敏感度为77.1％,特异度为54.0％,诊断临界值为11.8 mm(P<0.001).非分层斑块组和分层斑块组9个月累计主要不良心血管事件发生率比较,差异有统计学意义(P=0.038),分层斑块组累计发生的MACE较多.结论 分层斑块不仅反映既往有斑块破裂或血栓形成的愈合史,还反映脂质斑块易损性,可能有预测未来冠状动脉事件潜在风险的价值.

目的 探讨光学相干断层成像技术(OCT)在冠状动脉钙化(CAC)病变介入诊疗中应用.方法 选择2017年1月至2019年1月于上海交通大学医学院附属第九人民医院心内科住院,临床诊断为冠心病,行冠状动脉造影和OCT的患者116例为研究对象,OCT提示CAC病变126处.回顾性调查患者一般资料、疾病史和药物服用情况,记录患者生化指标及OCT成像指标.结果 (1)根据有无钙化斑块分为非钙化组68例(74个斑块)和钙化组48例(52个斑块),钙化组小而密LDL-C、尿酸水平高于非钙化组(P＜0.05,P＜O.01).(2)OCT斑块特征分析发现,钙化斑块微血管化(55.77％ vs 32.43％)、胆固醇结晶(61.54％ vs 33.78％)和薄纤维帽粥样斑块(TCFA)(46.15％ vs 22.97％)发生率高于非钙化斑块(P ＜0.05,P＜0.01).(3)对52个钙化斑块特征的OCT分析结果显示,钙化弧度为(108.1±72.6).,钙化深度(57.27±89.46) μm,钙化厚度(0.85±0.37)mm,钙化长度(5.67±5.32)mm,最大钙化面积(2.68 ±2.82)mm2.(4)在所有患者中对30处(非钙化组19处,钙化组11处)靶血管行介入治疗,发现PCI术后钙化组获得的最小管腔面积[(5.69±1.72) mm2 vs1 (7.12±1.43) mm2]、最大管腔面积[(8.71±1.27)mm2vs (10.58 ±2.52)mm2]均小于非钙化组;钙化组需要的支架长度[(34.80±12.70) mm vs(24.60 ±5.18)mm]长于非钙化组;钙化组支架贴壁不良发生率(81.82％ vs 36.84％)高于非钙化组,差异有统计学意义(P＜0.05,P＜0.01).结论 CAC斑块具有易损特征,对于CAC病变的介入治疗应该应用OCT指导优化,以改善患者的预后.

目的 探讨脂蛋白相关磷脂酶A2(Lp-PLA2)活性水平联合肌钙蛋白(cTn)对急性心肌梗死(AMI)的早期诊断价值.方法 连续收集2019年1月至12月来我院胸痛中心做冠脉造影的患者182例.根据造影结果,患者分为AMI组和稳定/不稳定型心绞痛组(SA/UA).结果 与SA/UA组比较,AMI组患者血清Lp-PLA2活性水平更高[(175.41±58.05)u/L比(152.28±46.82)u/L,P<0.01].Lp-PLA2与年龄和低密度脂蛋白(LDL)存在正相关.Lp-PLA2活性ROC曲线下面积(AUC)为0.612(95％CI:0.514～0.709,P=0.030),Lp-PLA2的cut-off值为156.5 u/L(敏感性61％,特异性62％).Lp-PLA2水平与AMI的患病率相关,OR为1.008[95％CI:1.000～1.016,P=0.043].结论 Lp-PLA2活性水平不依赖于肾功能,联合cTn I,可作为胸痛患者AMI的早期生物学标志物之一.

目的:探讨脉压(PP)、脉压指数(PPI)与冠脉钙化严重程度的关系.方法:回顾性分析我院心内科冠心病患者255例的临床资料,根据冠脉有无钙化及钙化病变的最大弧度分为无钙化组(63例),轻度钙化组(127例),重度钙化组(65例),比较3组之间的外周动脉血压、PP、PPI水平.钙化患者再按PP水平分为低PP组(42例),中PP组(109例),高PP组(41例),比较各组间血压及钙化情况.分析影响冠脉重度钙化的因素.结果:1、与无钙化组和轻度钙化组相比,重度钙化组收缩压[(136.2±13.7)mmHg、(136.2±14.1))mmHg比(144.6±14.2)mm-Hg]、PP[(54.1±11.0)mmHg、(56.8±11.2)mmHg,比(69.9±13.8)mmHg],PPI[(0.40±0.06)、(0.42±0.06)比(0.48±0.07)]均显著升高,舒张压[(82.1±10.7)mmHg、(79.3±9.2)mmHg比(74.7±11.0)mmHg]显著下降,P均<0.01;2、与低、中PP组比较,高PP组血管钙化长度[(7.35±6.14)mm、(8.99±7.58)mm比(14.37±8.87)mm],最大钙化角(103.48±58.03)°、(139.78±105.56)°比(245.83±105.12)°],病变长度[(16.34±6.90)mm、(17.61±7.78)mm比(21.34±10.78)mm]均显著增加,P<0.05或<0.01;3、二元Logistic回归分析显示,PP和年龄为冠脉重度钙化的独立危险因素(OR=1.084、1.052,P=0.001、0.029).结论:PP可能在冠脉钙化的发生发展中发挥作用,并能够预测冠脉重度钙化.

目的 探讨冠状动脉病变特征与支架置入术后斑块脱垂的关系.方法 回顾性分析2017年1月至2019年5月于上海交通大学医学院附属第九人民医院心内科住院诊断为急性冠状动脉综合征的33例患者,均行冠状动脉造影和支架置入术,术中行光学相干断层成像(OCT)检查,收集支架置入术前及术后OCT的斑块成像指标.结果 根据有无斑块脱垂分为斑块脱垂组(22例)和无斑块脱垂组(11例),两组患者基线资料比较,差异均无统计学意义(均P>0.05).斑块脱垂组患者C反应蛋白[(4.93±3.42)mg/L比(1.36±0.25)mg/L,P<0.001]、肌红蛋白[(245.11±349.05)ng/ml比(55.35±51.97)ng/ml,P=0.020]、白细胞计数[(8.59±2.41)×109/L比(5.90±1.52)×109/L,P=0.002]均大于无斑块脱垂组,差异均有统计学意义.斑块脱垂组平均脂质弧[(277.80±63.40)°比(227.73±29.61)°,P=0.004]与白色血栓(12/22比0.0,P=0.002)、红/混合血栓(10/22比0.0,P=0.007)、夹层(12/22比1/11,P=0.013)及薄帽纤维粥样斑块(TCFA)(18/22比1/11,P<0.001)比例均大于无斑块脱垂组,差异均有统计学意义.Kendall tau-b相关系数分析显示,斑块脱垂与TCFA(r=0.694,P<0.001)、纤维帽厚度(r=0.543,P<0.001)、脂质弧度(r=0.304,P=0.028)、夹层(r=0.439,P=0.009)、白色血栓(r=0.533,P<0.001)、红色血栓(r=0.466,P<0.001)均有相关性.斑块脱垂组最小管腔面积明显小于无斑块脱垂组[(5.73±1.67)mm2比(8.06±2.50)mm2,P=0.003],但合并血栓脱垂比例(9/22比0.0,P=0.013)显著高于无斑块脱垂组,差异均有统计学意义.结论 斑块脱垂与冠状动脉脂质斑块包括脂质弧、夹层、合并血栓等特征密切有关;并提示术后获得的管腔面积也更小.

Objective:To explore the application of optical coherence tomography (OCT) in the interventional diagnosis and treatment of intermediate coronary disease.Methods:Patients were enrolled during January 2017 to January 2019, in the Department of Cardiology, the Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine.The patient whose diagnosis was confirmed as intermediate coronary artery lesion by coronary angiography then underwent coronary OCT examination.The general information, disease history, drug use, biochemical indicators and OCT imaging indicators were collected.Results:(1)A total of 75 borderline lesions were detected in 69 patients with coronary heart disease, including 52 cases of left anterior descending artery (LAD) (75.4%), 4 cases of left circumflex artery (5.8%, 4/69), and 19 cases (27.5%, 19/69) of right coronary artery (RCA). (2) According to the analysis of the plaque characteristics of borderline lesions OCT, 7 cases were accompanied with thrombosis, 6 cases with plaque rupture, 25 cases with thin fiber cap lipid plaque, 49 cases with macrophages, 35 cases with microvascular, 35 cases with cholesterol crystallization, 3 cases with ulcer and 6 cases with intimal dissection.(3)The median of the minimum lumen area (MLA) determined by OCT was 2.9 mm 2.In the MLA<2.9 mm 2 group, C-reactive protein (CRP) ((2.92±2.44) mg/L vs.(1.98±1.30) mg/L, P=0.045), total cholesterol (TC) ((4.13±0.78) mmol/L vs.(3.74±0.75) mmol/L, P=0.041), low density lipoprotein cholesterol ((2.77±0.83) mmol/L vs.(2.22±0.78) mmol/L, P=0.007), small and dense LDL ((1.02±0.44) mmol/L vs.(0.80±0.34) mmol/L, P=0.024), lipoprotein a ((1.16±0.17) mg/L vs.(0.95±0.09) mg/L, P=0.042) were significantly higher than those in MLA≥2.9 mm 2 group.(4). According to the interventional strategy, patients were divided into two groups: percutaneous coronary intervention (PCI) group (N=16) and non-PCI group (N=59). The area stenosis (AS%) ((68.58±4.90)% vs.(63.10±7.09)%, P=0.001), diameter stenosis (DS%) ((65.65±6.91)% vs.(60.77±8.41)%, P=0.024), lipid plaque curvature ((245.3±41.0)° vs.(189.8±99.6)°, P=0.001), lipid plaque length ((19.11±6.40) mm vs.(14.72±9.30) mm, P=0.035) were deteriorated significantly in the PCI group than those in non-PCI group, the differences were all of them were statistically significant.(5)The incidence of 1-year major cardiovascular adverse events (MACE) was 6.25% in Oct guided PCI group and 5.08% in patients without PCI.There was no significant difference between the two groups ( P=0.317). Conclusion:According to the OCT assessment in the intermediate coronary lesions, it is found that the smaller the luminal area, the higher the serum LDL cholesterol level.More Interventional therapy were performed in the vulnerable plaques with large lipid cores.Decision-making for intermediate lesion was highly depended on the plaque tissue characteristics, rather than just MLA size.

Objective :To analyze correlation among fasting (FBL) and postprandial blood lipids (PBL) ,blood lipid fluctuation (absolute value of PBL‐FBL) and severity of coronary artery disease .Methods :Cross‐sectional study was performed among 264 patients undergoing coronary angiography (CAG) in our hospital .According to percutaneous coronary intervention (PCI) or not based on CAG results ,patients were divided into plaque group (n＝128) and PCI group (n＝136).Gensini score was used to assess severity of coronary artery disease .Blood lipid levels and its fluctu‐ation were compared between two groups .Correlation among blood lipid levels ,blood lipid fluctuation and severity of coronary artery disease were analyzed .Results :Compared with plaque group ,there were significant rise in per‐centages of men and smokers ,waist circumference ,levels of postprandial‐fasting (P‐F ) serum LDL‐C (ΔLDL‐C ) and P‐F plasma apolipoprotein B (ΔApoB ) , and significant reduction in plasma level of P‐F apolipoprotein A1 (ΔApoA1) in PCI group , P＜0. 05 or ＜ 0. 01. Pearson correlation analysis indicated that serum fasting and post‐prandial HDL‐C levels ,plasma fasting and postprandial levels of ApoA1 and ΔApoA1 were significant inversely cor‐related with Gensini score ( r＝ －0. 130～ －0.218 , P＜0. 05 or ＜0. 01) ,and levels of plasma fasting lipoprotein a (Lp (a)) ,serum fasting and postprandial levels of free fatty acid (FFA) ,serum P‐F FFA (Δ FFA) were significant positively correlated with Gensini score ( r＝0. 139－0. 176 , P＜0.05 or ＜0.01).Multifactor linear regression anal‐ysis indicated that postprandial serum HDL‐C was protective factor for Gensini score (B＝ －22.274 , P＝0.002 ) , while postprandial serum FFA ,Δ FFA ,waist circumference and hyperlipidemia history were its influencing factors (B＝0. 388～24. 135 , P＜0. 05 or ＜0.01).Conclusion :Measurements of fasting and postprandial blood lipid levels and their fluctuation contribute to more comprehensively and objectively assessing blood lipid levels and severity of coronary disease in patients with coronary artery disease .

Objective To study the effectiveness of danlou tablets on chronic heart failure in the patients.Meth-ods The patients with less than 50% LVEF in echocardiography were selected as the subjects.A total of 96 cases were included and randomized into two groups.In the treatment group,the routine medicines and danlou tablets were used.In the control group,only the routine medicines were prescribed.The indexes of the therapeutic effects were compared between the two groups after 3-month treatment.Results Compared with those before treatment,BNP was reduced obviously(P <0.05),EF value improved obviously(P <0.001),CRP reduced significantly(P <0.05),the 6min walking distance in-creased obviously(P <0.05),the self-assessment of exercise tolerance increased obviously(P <0.001)and the exercise tolerance score in VASQ improved apparently(P <0.001)in the treatment group after treatment.Regarding the effects on TCM symptoms,after treatment,the effects in the treatment group with symptomatic formula were better obviously than the control group(P <0.05).Conclusion Danlou tablets obviously relieve the symptoms and improve the living quality of the patients with chronic heart failure.

Objective: To explore therapeutic effect of in-hospital intravenous alprostadil injection on patients with acute myocardial infarction (AMI) complicated diabetic nephropathy (DN) undergoing percutaneous coronary intervention (PCI), and evaluate their long-term prognosis.Methods: A total of 80 AMI + DN patients undergoing PCI were selected from our hospital.They were randomly divided into alprostadil group (n=40) and routine treatment group (n=40).Renal function after PCI, cardiac function during hospitalization, serum creatinine (Scr) level on 72h after PCI and incidence of major adverse cardiovascular events (MACE) within one-year follow-up were compared between two groups.Results: Compared with routine treatment group on 72h after PCI, there was significant reduction in Scr level [(126.92±35.28) μmol/L vs.(104.32±22.91) μmol/L], and significant rise in estimated glomerular filtration rate [eGFR, (55.23±31.48) ml·min-1·1.73m-2 vs.(62.14±36.23) ml·min-1·1.73m-2] in alprostadil group, P<0.05 both.Postoperative one-year follow-up indicated that there were no significant difference in incidence rate of MACE and percentage of kidney replacement therapy between two groups, P>0.05 all.Conclusion: Intravenous alprostadil injection based on routine treatment possesses significant therapeutic effect on renal function in AMI + DN patients after PCI, and it's safe

Objective To study the possible influencing factors in the formation of coronary collateral circulation in patients with chronic total occlusion (CTO). Methods Patients were enrolled having at least 1 major coronary artery angiography revealed as CTO of 144 patients. According to the Rentrop classification, patients with grade 0 and grade 1 filling were catogorized as insufficient collateral circulation group (n=72) and patients with grade 2 and grade 3 filling as collateral circulation group (n=72). Serum biomarkers and insulin-resistance by HOMA model were also studied in all patients. Results In the insufficient collateral circulation, BMI,TC,ApoB, lipoprotein a, fasting insulin HOMA-IR,HOMA- beta, CRP was significantly higher than the well collateral circulation group and ApoA-Ⅰ, ISI lower than the well collateral group ( all P ﹤0. 05 ) . Bivariate correlation alaysis showed. Rentrop score, BMI, TC, ApoB, lipoprotein a, fasting insulin, HOMA-IR,HOMA- beta and CRP are positively correlated to the formation of collateral circulation ( P ﹤ 0. 05 ); ApoA-Ⅰ and ISI were negatively correlated ( P ﹤0. 05 ) . Logistic regression analysis after calibration with weight, ApoA-Ⅰ and HOMA-beta factors, lipoprotein a ( OR&nbsp;7. 575,P=0. 009), TC (OR 2. 154,P =0. 001) were found to be the independent factors of coronary collateral circulation formation. Conclusions TC, lipoprotein a, obesity, CRP, and HOMA-IR are correlated with the formation of coronary collateral circulation and may predict formation of collateral circulation in patients with CTO.

目的 比较喀什地区和上海地区急性心肌梗死患者的流行病学特征与治疗方案差异,为提高急性心肌梗死的防治水平提供参考依据.方法 收集2012年8月～ 2013年1月喀什地区第二人民医院心内科收治的急性心肌梗死患者94例和上海第九人民医院心内科收治的急性心肌梗死患者59例,随访时间6个月,对比两地急性心肌梗死患者的发病年龄、性别、冠心病危险因素、文化水平、收入、到院时间、Killip心功能分级、治疗方案及预后、随访心超情况.结果 喀什地区急性心肌梗死患者的发病年龄小于上海,男性患者比例高于上海(P＜0.01).经济状况和文化水平低于上海患者,发病至就诊时间长于上海患者(P＜0.01).喀什患者β受体阻滞剂的应用率低于上海(P＜0.05),再灌注治疗及经皮冠状动脉介入治疗(PCI)率均明显低于上海患者(P＜0.01).半年后随访,喀什地区心肌梗死继发心力衰竭者明显多于上海(P＜0.05).结论 喀沪两地急性心肌梗死患者在性别、年龄、危险因素分布上存在差异,喀什地区β受体阻滞剂的应用率及再灌注率、PCI率较低,并发心力衰竭患者多,需有针对性地加以改进,以提高当地心肌梗死患者的预后.

Objective To identify the risk factors for acute myocardial infarction( AMI) in patients of different age groups and to analyze the coronary angiographic imaging. Methods Two hundred and fifty patients with AMI were enrolled and assigned into three age groups,the premature group( male below 55 years old and female below 65 years old),the middle and elderly group( male between 55 and 80 years old,female between 65 and 80 years old) and the senior elderly group( beyond 80 years old). The comparison of clinical features was conducted among groups. Results The statistical data collected for the three groups were male raito 95% vs 80% vs 52%( P 0. 001); smoking ratio 84% vs 72% vs 35%( P 0. 001); diabetes ratio 16. 3% vs 32. 5% vs 40. 5%( P = 0. 04); waist size( 92. 2 ± 7. 9) vs( 89. 6 ± 9. 6) vs( 84. 8 ± 10. 2) cm( P = 0. 04); LDL-C levels( 3. 5 ± 1. 4) vs( 3. 1 ± 0. 9) vs( 2. 8 ± 0. 80) mmol·L-1( P = 0. 04). The infarct-related vessel was mostly left anterior descending coronary artery. Vessel lesions of single,double and triple coronary arteries in proportion ofthe three groups were 56. 3% vs 23. 8% vs 21. 4%,12. 5% vs 40. 5% vs 14. 3%,31. 2% vs35. 7% vs 64. 3%( P = 0. 04). Intracoronary thrombus aspiration rate of the three groups had a significant difference( 44% vs 22. 8%vs 6. 9%,P = 0. 005). Family history of cardiovascular disease ratio were 16. 7% vs 5%( P = 0. 02),in the premature group and the middle-aged elderly group. BMI,the prevalence of hypertension,TC,TG,HDL-C,uric acid,glucose levels were not significantly different among the three groups. Conclusions Male,current smoking,abdominal obesity,family history of cardiovascular as well as LDL are major risk factors among patients with premature AMI who mainly had single coronary lesion but heavy intracoronary thrombus burden.Diabetes is a more important risk factor than others for the elderly with AMI who usually had multivessel lesion and light intracoronary thrombus burden.

Objective:To explore the relationship between arterial plasma levels of von Willebrand factor (vWF) and cardiovascular events in patients with stable coronary heart disease (CHD) .Methods :A total of 88 stable CHD pa‐tients from Aug 2007 to Dec 2008 , were enrolled ,their clinical ,coronary angiography (CAG) and percutaneous coronary intervention (PCI) data were collected .Enzyme linked immunosorbent assay was used to measure arterial (aortic root) plasma vWF level before PCI .Except two lost cases ,according to baseline vWF level ,other patients were divided into high vWF level group (vWF≥13.5 ng/ml ,n=43) and low vWF level group (vWF <13.5 ng/ml , n=43) .Incidence rate of major adverse cardiovascular events (MACE) ,including mortality rate ,non-fatal acute myocardial infarction (AMI) , CAG+PCI etc .after six years were followed up .Results:After a mean 74.7 months follow-up ,there were no significant difference in mortality rate (9% vs . 9% ) ,person‐time of non‐fatal AMI (12% vs .7% ) ,arrhythmia (9% vs .16% ) ,CAG+ PCI (53% vs .67% ) ,heart failure (30% vs .23% ) ,cere‐brovascular incident (14% vs .26% ) between low vWF level group and high vWF level group ,P>0.05 all .Conclu‐sion:In patients with stable coronary heart disease ,level of von Willebrand factor is not significantly related to long-term cardiovascular events .

Objective To investigate the safety, efficacy and influence on branch vessels of rotational atherectomy via radial approach in patients with heavily calciifed coronary lesions in drug-eluting stents (DES) era. Method From January 1, 2012 to June, 30, 2014, 24 cases treated with rotational atherectorny in our hospital were included. Coronary lesions and procedure parameters, complications, branch vessels and major adverse cardiovascular events were analyzed. Result 24 cases with 26 heavily calcified coronary lesions were treated successfully with rotational atherectorny via radial approach and no complication was observed. The degree of stenosis went down signiifcantly from (89.5±7.3)%to (37.6±5.6)%. DES implantation was successfully applied to all cases after rotational atherectomy. A total of 20 distal branch vessels were analyzed after rotational atherectorny and no embolization, dissection or signiifcant vessel diameter change occurred. 2 patients died 4 and 15 months after rotational atherectorny because of severe pneumonia. The remaining patients survived well without major adverse cardiovascular events during (11.0±6.1) months follow-up. 6 patients received the coronary angiography follow-up and no in-stent restenosis, thrombosis and late stent malapposition was found. Conclusion In DES era, via radial approach rotational atherectorny is a safe and&nbsp;efifcient technique for treating heavily calciifed coronary lesions and does not affect distal branch vessels.

目的：观察益心舒胶囊治疗慢性闭塞病变冠心病的疗效。方法选取冠脉造影结果显示至少1支主要冠状动脉血管为慢性闭塞病变的144例患者。随机分为两组，常规组给予常规药物治疗，益心舒组在常规药物治疗的基础上给予益心舒胶囊治疗6个月。结果益心舒组治疗后每周心绞痛发作次数由治疗前的(2.15±0.91)次减少为(1.01±0.76)次(P<0.05)，同时6 min步行距离由治疗前392 m±147 m增加为518 m±184 m(P<0.05)，患者自评运动耐量评分由治疗前3.00分±0.93分提高为3.96分±1.23分(P<0.05)，退伍军人特定活动问卷(VSAQ)评估患者运动耐量评分由治疗前3.47分±0.88分提高为5.13分±1.37分(P<0.05)。常规治疗组并未见有明显改善。结论益心舒胶囊对慢性闭塞病变冠心病的治疗能明显改善症状，提高生活质量。

Objective:To explore therapeutic effect and prognosis of thrombus suction in patients with acute ST seg-ment elevation myocardial infarction (STEMI)during percutaneous coronary intervention (PCI).Methods:A total of 105 STEMI patients were enrolled and divided into thrombus suction + PCI group (n=34,received thrombus suction + PCI therapy)and routine PCI group (n=71,received routine PCI treatment).Postoperative TIMI flow, cardiac function during hospitalization,incidence of major adverse cardiovascular events (MACE)and rehospitaliza-tion within one-year follow-up after PCI were compared between two groups.Results:Compared with routine PCI group,there were significant reductions in peak values of creatine kinase isoenzyme [CK-MB,(236.62± 133.00) ng/ml vs.(186.47±69.20)ng/ml]and creatine kinase [CK,(2833.39± 198.70)ng/ml vs.(2129.59± 199.40) ng/ml],peak time of CK-MB [(12.38±6.70)h vs.(9.65±3.90)h]and CK [(12.80±8.10)h vs.(9.68± 3.50)h]after blood flow recovery,P < 0.05 all in thrombus suction + PCI group;there were downtrend of MACE (19.7% vs.8.8%)and rehospitalization rate (66.2% vs.50.0%)in thrombus suction + PCI group,but no significant difference between routine PCI group and thrombus suction + PCI group during one-year follow-up,P >0.05. Conclusion:Thrombus suction is help for improving patients condition,reducing enzymology level may be effect improving prognosis.

目的:前瞻性随访分析经桡动脉旋磨术对老年冠心病(CHD)患者钙化病变的疗效.方法:2012年6月至2014年5月,入选了24例老年冠心病患者,收集其临床、冠状动脉造影(CAG)和经皮冠脉介入(PCI)的资料.随访观察PCI围手术期(桡动脉穿刺开始至出院)及出院后随访期的无复流、冠脉破裂/穿孔、以及死亡、非致死性急性冠脉综合征(ACS)、再次PCI等主要不良心血管事件(MACE).结果:24例患者均成功经桡动脉实施了冠脉旋磨术及支架植入.围手术期仅发生1例前降支远端夹层和角支闭塞(旋磨导丝所致)(4.17％),无其它MACE现象发生;随访期因肺炎呼吸衰竭死亡1例(4.17％),心绞痛发生1例(4.17％),其余患者均无MACE发生.结论:经桡动脉冠脉旋磨术治疗老年冠心病钙化病变安全、有效、易行.