Objective: To evaluate the inlfuence of glycosylated hemoglobin (HbA1c) on long-term prognosis of elderly patients with acute myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods:A total of 233 acute myocardial infarction patients with age ≥60 years old who received primary PCI during June 2008 to December 2012 and folowed up >1 year after charge were included in this study. Blood sample for HbA1c were obtained on the first 24 h after admission. Patients were classified into three groups: group I (HbA1c≤5.6%;n=46); group II (5.7%≤ HbA1c ≤6.4%;n=92); and group III (HbA1c ≥6.5%;n=95).Results:The patients were followed up for a mean period of (977±438) days. Totally 12 patients (5.2%) died and MACE occurred in 18 patients (7.7%).The patients were divided into diabetes group and diabetes-denied group. MACE and mortality in one year which were equal in diabetes-denied was higher in group III (12.5%) compared with group II (2.6%) and group I (0%;P=0.026), but there were not different between group II and group I. In diabetes group, group I and group II were merged to compare with group III, the differences of MACE and mortality in one year were not found between them in the result. After multivariate analysis, HbA1c (hazard ratio, 1.258; 95% CI: 1.114-1.421;P<0.001) was independently associated with long-term (more than 1 year) mortality.Conclusion:The HbA1c is an independent predictor of long-term outcomes in elderly patients with acute myocardial infarction treated with primary PCI. HbA1c ≥6.5 were associated with MACE and mortality in 1 year for the diabetes-denied patients.

Objective: To evaluate the relationship between HbA1c levels and the severity of coronary artery stenosis in patients with acute ST-segment-elevation myocardial infarction(STEMI) without diabetes mellitus.Methods:111 cases of acute STEMI and received percutaneous coronary angiography patients with non DM who obtained the clinical characteristics,HbA1c,fasting blood glucose(FBG),blood lipids and other biochemical indicators,according to the patient's HbA1c values were divided into two groups, group A (HbA1c=5.6%, group B (52 cases), HbA1c 5.7%~6.4%, 59 cases). The use of the Gensini score to assess the severity of coronary artery lesions.Results:In the 111 patients, 82% male, smoking accounted for 73.9% of hypertension accounted for 51.4%, multivessel disease incidence rate is 76.6%. Group B patients with FBG, Gensini score and the proportion of multivessel disease were significantly higher than those in group A.HbA1c and Gensini scores were positively (P=0.006). Multiple stepwise regression analysis showed that in the non DM patients with acute STEMI, HbA1c and age were independent risk factors of Gensini score (P<0.05).Conclusion:HbA1c were the independent risk factors for the severity of coronary artery stenosis in patients with acute STEMI without diabetes mellitus.

A total of 149 acute myocardial infarction patients undergoing primary PCI in the first 24 hours were an-alysed, including 112 RCA-infarct-related artery(RCA group) and 37 LCX-infarct-related artery(LCX group) AMI patients. Compaerd with RCA-related MI, patients with LCX-related MI had less ratios of right ventricular myocar-dial infarction,atrioventricular block(P < 0. 05),but longer onset to admission time,higher rates of heart failure as well as chest dirtress(P < 0. 05). The accuracy and sensitivity of electrocardiogram on LCX-related MI positioning was lower(P < 0. 05), LCX-related NSTEMI incidence was higher(P < 0. 05), and less cases of right dominance in coronary angiography occurred in LCX group(P < 0. 05). Furthermore,proximal LCX occlusion was more fre-quently presented.

Objective To evaluate the influence of glycosylated hemoglobin on admission ( HbA1c) on long-term outcomes of patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Methods A total of 305 patients with acute ST-segment elevation myocardial infarction ( STEMI) received primary percutaneous coronary intervention from Dec 2007 to Dec 2012 were enrolled in this study. HbA1c was measured on admission for all patients. Clinic characteristics、biochemical indicator, death and major adverse cardiac events ( MACE) during follow up were recorded. Patients were classified into three groups: group 1(HbA1c≤5. 6%,n=85); group 2 (5. 7%≤HbA1c≤6. 4%,n=117); and group 3 (HbA1c≥6. 5%,n=103). Results The patients were followed up for a mean of (1 075 ± 414) days. 23 patients ( 7. 5%) died and MACE occurred in 37 patients ( 12%) . MACE rate in one year was higher in group 3 ( 8. 7%) than in group 2 ( 2. 6%) and group 1 ( 1. 2%; both p < 0. 05 ) . One-year mortality rate was higher in group 3 ( 5. 8%) than in group 2 ( 0. 9%) and group 1 ( 0 ) %, both p <0. 05). Elevated HbA1c (p =0. 010) was associated with long-term (more than 1 year) MACE. After multivariate analysis, HbA1c (HR:1. 34, 95%CI:1. 099-1. 633, p=0. 004) was independently associated with long-term (more than 1 year) mortality. Conclusions HbA1c is an independent predictor of one-year and long-term outcomes in STEMI patients treated with primary percutaneous coronary intervention.

Objective To evaluate the related factors and clinical features of coronary artery atherosclerosis proximal to myocardial bridging (MB) in elderly patients.Methods 603 patients with MB-mural coronary artery (MB-MCA) detected by angiography at the first time in our hospital were enrolled.Clinical and angiographic data of them were collected.Patients were divided into the elderly group (n＝229,aged 60 86 years) and young group (n=374,aged 28-59 years).The related factors for coronary artery atherosclerosis proximal to MB were analyzed by multivariate analysis.Clinical features were compared between the two groups.Results The proportion of patients with typical chest pain,acutc coronary syndrome (ACS),hypertension was higher in the elderly group than in the young group (x2 =8.61,41.12,24.97 respectively,all P＜0.01).The courses of hypertension and diabetes were longer in the elderly group than in the young group (t=5.25 and 2.57,P＜0.01 or 0.05).The proportion of atherosclerotic lesions proximal to MB was higher and the degree of atherosclerosis was more serious,lesions were mainly located in vascular bifurcate place,the degree of atherosclerosis in non-MB-MCA was more serious,the number of the coronary non-MB-MCA arteries was much more,and systolic narrow rate was higher in MB-MCA (P＜0.01 or 0.05).The proportion of previous and current smokers were higher,the proportions of patients with family histories of hypertension,diabetes and coronary heart disease were higher,and serum triglyceride level was higher in the young group than in the elderly group (P＜0.01 or 0.05).Multivariate regression analysis suggested that the related factors for first coronary artery atherosclerosis proximal to MB sequenced by β value were narrow rate of non-MB-MCA with the most severe degree of narrow,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA and diabetes and dyslipidemia in the elderly group according to β value (βvalue:0.397,0.273,0.201,0.140,0.120 and 0.109,respectively,all P＜ 0.05).The related factors for the severe degree of coronary artery atherosclerosis proximal to MB sequenced by Beta value were non-MB-MCA,vascular bifurcation lesions,male,diabetes and systolic narrow rate of MB-MCA (β value:0.455,0.246,0.148,0.110 and 0.109,respectively,P＜0.01 or 0.05).Conclusions There are more risk factors for coronary artery disease and a higher incidence of coronary heart disease in elderly patients with MB-MCA.Lesions of non-MB mural coronary artery,vascular bifurcation lesions,male,systolic narrow rate of MB-MCA,diabetes and dyslipidemia may be closely related with coronary artery atherosclerosis proximal to MB.

OBJECTIVE:To explore the imaging and clinical characteristics and related risk factors of patients with coronary artery stenosis located proximally to myocardial bridging.METHODS:This study enrolled 603 patients with angiography evidenced myocardial bridging-mural coronary artery between May 2004 to May 2009. Angiographic and clinic data were collected according to uniform protocol and standard questionnaires were used to obtain patients' demographic and clinical information. Univariate and multivariate analysis were performed to explore related risk factors.RESULTS:Chest pain was present in 247 cases (41.0%). Dynamic ST-T changes were found in 229 cases (38%). A total of 644 myocardial bridging-mural coronary arteries were detected including 382 (62.4%) segments located proximally to myocardial bridging. Diastolic vessel diameters in the myocardial bridging segment were significantly smaller than reference segments (all P < 0.01). Stepwise multiple regression analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male gender, diabetes, and systolic narrow rate of myocardial bridging-mural coronary arteries were positively related with the narrowing degree of the first coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non- myocardial bridging-mural coronary arteries, age, LDL-C/HDL-C, male, diabetes and dyslipidemia were positively related with the narrowing degree of the most severe coronary artery stenosis located proximally to myocardial bridging (P < 0.05 or P < 0.01).CONCLUSIONS:Myocardial ischemia is common in patients with myocardial bridging and the artery segments located proximally to myocardial bridging are prone to stenosis. Systolic narrow rate of myocardial bridging-mural coronary arteries is one of major determinants of coronary artery stenosis located proximally to myocardial bridging. Whereas the other coronary heart disease risk factors are likely to play more important roles.

OBJECTIVE:To explore the clinical predictive factors of coronary artery stenosis located distally to myocardial bridging (MB).METHODS:A total of 603 patients with MB-mural coronary artery (MB-MCA) diagnosed by angiography initially were enrolled during May 2004 to May 2009. Their angiographic and clinical data were collected according to an uniform protocol. And standard questionnaires were used to acquire demographic information and clinical examinations. Univariate and multivariate analysis were performed to explore the related clinical predictive factors.RESULTS:A total of 644 MB-MCAs were detected. Diastolic vessel diameters in MCAs were significantly smaller than those in reference segments ( (2.29 ± 0.39) vs (2.48 ± 0.40) mm, P < 0.001) . Lesions located distally to MB detected in 36 patients were significantly fewer than those proximally to MB in 382 patients (5.9% vs 62.4%, P < 0.001) . Univariate analysis suggested that the narrowing degree of vessel located proximally to MB, the narrowing degree and the number of diseased coronary vessels of non-MB-MCAs and course of hypertension were positively correlated with the narrowing degree of vessel located distally to MB (all P < 0.05) . Multivariate Logistic regression analysis suggested that the number of cigarettes per day, the narrowing degree of diseased coronary vessels of non-MB-MCAs, the narrowing degree of vessel located proximally to MB and diastolic narrow rate of MCA were positively correlated with the occurrence of coronary artery stenosis located distally to MB (all P < 0.05) . Their standardized coefficients (β) were 0.763, 0.727, 0.420 and 0.403 respectively. And the corresponding Exp (β) were 2.146 (1.089-4.229) , 2.070 (1.371-3.125) , 1.521 (1.050-2.204) and 1.496 (1.094-2.045) .CONCLUSION:The number of cigarettes per day, the narrowing degree of diseased coronary vessels of non-MB-MCAs, the narrowing degree of vessel located proximally to MB and diastolic narrowing rate of MCA are likely to be important clinical predictive factors of coronary artery stenosis located distally to MB.

Objective: The purpose of this study was to determine the prevalence of coronary angiographically evident atherosclerotic stenosis associated with myocardial bridging (MB) and to explore related risk factors of coronary artery stenosis located proximally to MB.Methods: Overall, 603 patients with MB-mural coronary arteries (MB-MCAs) diagnosed by angiography initially were enrolled in this observational study during May 2004 to May 2009. One-way ANOVA, t-test, Pearson correlation test and stepwise multiple regression analysis were performed to explore related risk factors.Results: Totally 644 MB-MCAs were examined. Prevalence of lesions located distally to MBs was significantly lower than those proximally to MBs [36 (5.9%) vs. 382 (62.4%), p<0.001]. Diastolic vessel diameters in MB segments were significantly smaller than reference segments p<0.001. Ulcer-like lesion was found in MB-MCA in 1 patient. Multivariate analysis suggested that vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non-MB-MCA arteries, age, low-density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C), male, course of diabetes, and systolic narrow rate (SNR) of MB-MCAs were positively related with the narrow degree of the first coronary artery stenosis (FCAS) located proximally to MBs (all p<0.05). Vascular bifurcation lesions, the degree of narrowing and the number of diseased coronary vessels of non-MB-MCA arteries, age, LDL-C/ HDL-C, male, diabetes and dyslipidemia were positively related with the narrow degree of the most severe coronary artery stenosis(MSCAS) located proximally to MB (all p<0.05).Conclusion: The intramural and distal portions of a bridged artery are not the forbidden zone of artery atherosclerosis formation. SNR of MB-MCA may be one of the important decision factors to coronary artery stenosis located proximally to MB.

Objective To investigate the clinical characteristics of acute non-ST-segment elevation myocardial infarction(NSTEMI) patients with total occlusion of infarct-related artery(IRA). Methods Consecutive 42 patients who had confirmed diagnosis of acute NSTEMI and experienced total occlusion of IRA detected by emergency angiography within 24 hours from the heart attack were enrolled.The clinical characteristics of these patients were stndied.Results In the patients whose IRA was circumflex artery,the proportion of good collateral circulation was lower compared with the patients whose IRA was anterior descending branch or right coronary artery(P0.05).In the patients with IRA being circumflex artery,the proportion of cases whose symptoms were persistent and were not alleviated before angiography was greater compared with other patients(P0.05).The proportion of patients with IRAs being right coronary artery,whose symptoms were not chest pain,was greater than the other patients(P0.05).Conclusion If classification was according to different IRAs,the acute NSTEMI patients with total occlusion of IRA have different characteristics.The total occlusion of circumflex artery which is apt to be missed by the standard ECG is worthy of attention.

Objective To evaluate the efficacy of overlapping homemade Excel vs cypher sirolimus eluting stents to treat diffuse disease of coronary arterial lesions.Method Total 51 patients with diffuse de novo coronary lesions underwent overlapping homemade Excel sirolimus eluting stents therapy were matched with the other 47 patients receiving overlapping cypher sirolimus eluting stents therapy.Clinical characteristics and follow-up results were compared between the two groups.Results Excel stent group had more three-vessel lesion and hyperlipoidemia patients,the rest aspects of baseline features in the two groups were similar.One-year MACE,defined as a hierarchical composite of total death,cardiac death,AMI,and target vessel revascularization,were all similar.Conclusion Overlapping homemade Excel sirolimus eluting stents in patients with a diffusely coronary arterial lesions is relatively safe and associated with good clinical outcomes.

目的:探讨管理慢性心力衰竭(CHF)患者的一种模式.方法:自2006年1月至2008年1月,159例CHF患者入选,干预组90例,对照组69例.比较两组患者的服药、再住院及死亡情况.结果:1年时两组服用ACEI(或ARB)制剂比例(71.1% vs 53.6%,P=0.03),β受体阻滞剂(63.3% vs 44.9%,P=0.03),两组的心力衰竭再住院情况(38.9% vs 56.5%,P=0.04);总死亡情况(13.3% vs 26%,P=0.06),心源性死亡情况(11.1% vs 24.6%,P=0.03).结论:应用医院-社区-家庭多元化模式管理CHF患者减少了再住院率和心塬性死亡率.

我院自2004年5月～20095月共收治4例以急性下壁ST段抬高心肌梗死(STEMI)为首发表现的主动脉夹层(AD)患者,对他们的临床特点进行总结,值得深思.

不稳定型心绞痛及急性非ST段抬高心肌梗死(NSTEMI)作为急性冠状动脉综合征重要的组成部分,有相似的发病机制和临床表现,常被归为一大类写入指南[1,2].

目的:探讨介入治疗时间对急性ST段抬高型心肌梗死（STEMI）早期心肌灌注及心功能的影响。方法:将272例STEMI在我院行急诊冠状动脉介入治疗（PCI）患者根据发病到开始PCI的时间分为两组,6h内为早期介入组（n=152）,6~12h为延迟介入组（n=120）。于入院72h内及PCI后6个月分别行超声心动图检查,测定左室射血分数（LVEF）。比较两组术后TI MI血流、LVEF及纽约心功能分级（NYHA）,判断心肌再灌注及心功能的状况。结果:两组患者术前基本临床情况无显著意义。早期介入组达TIMI3级率显著高于延期介入组（90.8%对78.3%,P＜0.05）。两组在出院前LVEF无统计学差异,术后6个月早期介入组LVEF明显高于延期介入组（59%对53%,P＜0.05）。结论:STEMI在发病6h内行PCI较发病6~12h内行PCI,更能改善心肌再灌注及远期心功能水平。

目的评价865例次经桡动脉冠状动脉介入诊治并发症情况。方法连续入选2005年8月至2006年12月我院冠状动脉介入诊治的病例865例次。分析常规经桡动脉介入诊治及并发症情况。结果(1)成功经桡动脉介入诊治856例次。(2)前臂血肿8例(0.9%);迷走神经反射3例(0.35%);假性动脉瘤1例(0.12%);一过性视力障碍者5例(0.58%);发生使介入操作延时的桡动脉痉挛9例(1.05%);经桡动脉介入诊治第二日穿刺侧脉搏较穿刺前明显减弱40例(4.67%),无脉者11例(1.29%)。结论常规经桡动脉进行介入诊治可行且并发症较少。

1 临床资料 患者,男性,48岁,因间断胸痛1年、复发加重1d人院.患者近1年余来间断胸痛,呈针刺样,位于左前胸骨下,范围约拳头大小,每次持续约10余分钟,可自行缓解,多于活动后出现,休息后缓解.入院1 d前再次于休息时出现上述症状,程度较前重,发作频繁,最长持续约20 min,不伴心悸、大汗、憋气,舌下含服速效救心丸症状可减轻.既往高血压病史8年余,血压最高160/110 mm Hg.吸烟20余年,每日约10支.体重指数:24 kg/m<'2>,查体无阳性发现.心电图无明显ST-T改变.心肌酶在正常范围;三酰甘油0.45 mmol/L、总胆固醇2.6 mmol/L、高密度脂蛋白胆固醇0.89 mmol/L、低密度脂蛋白胆固醇1.52 mmoL/L;经葡萄糖耐量试验确诊为2型糖尿病.

冠状动脉心肌桥作为一种先天性的解剖变异在临床上并不少见,一般被认为是一种良性病变.然而随着冠状动脉造影技术的普及,心肌桥已被认为是心肌缺血的病因之一,可引起严重心脏事件.

Objective To investigate the application of China-made tirofiban in the treatment of acute ST elevation myocardial infarction (STEMI) with large thrombus burden during primary percutaneous coronary intervention (PCI). Methods Ninety eight STEMI patients with large thrombus burden detected by emergent coronary angiography were divided into two groups: tirofiban group (52 cases) and control group (46 cases). Coronary flow, ST segment resolution magnitude,clinical events were recorded. Results There was no difference in the achievement of TIMI 3 flow between two groups. Corrected TIMI frame count (CFTC)was lower [((31.2±3.6)fram vs.(23.6±9.1)fram vs. (61.2±13.1) %, P0.05 ] and ST segment resolution magnitude was higher in the tirofiban group [(38.9±12.6 )% vs.(61.2±13.1)%, P0.05 ] than in the control group. There was no difference in the rate of hemorrhage and cardiovascular events in hospital between two groups. Conclusions Using of tirofiban within short periods can safely improve coronary flow and myocardial perfusion during PCI.

Objective:To investigate the detection rate and predictors of renal artery stenosis(RAS)in patients undergoing renoarteri- ography.Methods:Retrospective analysis was made based on the clinical and angiographic data of patients undergoing renal arteriogra- phy after performing coronary arteriography during January 2003 and January 2005.Results:(1)Detection rate of significant RAS was 13.3% in 1049 patients.The rate was 20.7% in 564 patients with coronary heart disease(CHD),which was significantly higher than that in patients without CHD.(2)Single factor analysis showed that the proportion of CHD,coronary artery calcification,old my- ocardial infarction,three-vessel coronary artery stenosis and hypertension,the level of low density lipoprotein cholesterol(LDL-C) and age were higher in RAS patients than those in controls.(3)Higher detection rates of significant RAS were found in patients with elder,high level of LDL-C,CHD and three-vessel coronary artery stenosis.(4)Multi-variance logistic analysis showed that age, serum creatinine,CHD and three-vessel coronary artery stenosis were the independent predictive factors.Conclusion:RAS was a fre- quent finding in patients with CHD.The clinical features of patients can predict the presence of RAS.

1资料 患者男,19岁,工人,因胸闷、胸痛1个月,发热1周,伴晕厥1次于2005年10月8日入院.患者既往体健,2005年9月初,无明显诱因突感胸闷、呼吸困难,间断发作,活动后加重,每次可持续数小时至1天.1周后出现胸痛,伴咳嗽、咳少量白痰、痰中带血,胸痛呈阵发性发作,为双侧前胸尖锐痛,呼吸及咳嗽时加重,持续半小时可缓解.3周后,患者于行走中突感心悸、恶心、大汗,随后出现意识丧失,摔倒在地,约10分钟后意识恢复.其后第3天出现发热,最高38度,于我院门诊疑诊胸膜炎,予以抗炎治疗.因症状不缓解疑诊心肌炎而住院.追问病史,近2个月出现右下肢疼痛,行走时加重.有3年吸烟史,2包/天.