目的:研究心力衰竭患者入院收缩压水平与院内死亡率的相关性,总结不同梯度血压与院内死亡相关性的特点,为改善心力衰竭患者的短期预后提供更多临床证据支持.方法:纳入心力衰竭住院的患者1 667例.分析收缩压低、中、高三组患者临床指标、超声心动参数差异;绘制平滑曲线描述入院收缩压与院内死亡的趋势;采用GAM模型进行阈值计算;构建分段Logistic回归模型探讨入院收缩压院内死亡的影响因素.结果:高收缩压组患者年龄更大(P=0.034),糖尿病(P=0.003)及高血压病患病率(P＜0.001)更高,TC及TG 水平更高(P＜0.001;P＜0.001),室间隔厚度及后壁厚度更大(P＜0.001;P＜0.001);低收缩压组血肌酐水平(P＜0.001)显著高于中、高收缩压组,LVESD(P=0.014)及E/a比值(P＜0.001)更大,LVEF更低(P＜0.001).整体心力衰竭患者院内死亡率为7.4％,其中低收缩压组(13.7％)显著高于中、高收缩压组(P＜0.001).绘制平滑曲线发现入院SBP与院内死亡率为"L"型曲线,采用GAM模型计算阈值为119mmHg.根据阈值进行两段Logistic回归分析,在入院收缩压＜119mmHg的心力衰竭患者中,入院收缩压越低(OR=0.977,95％CI:0.956～0.997,P=0.028)、年龄越大、合并高血压、空腹血糖越高、LVEF越低增加院内死亡风险;在入院收缩压≥119mmHg的心力衰竭患者中,合并高脂血症,血肌酐水平越高,空腹血糖越高增加院内死亡风险.结论:以119mmHg为阈值分组,两组患者的入院收缩压与院内死亡相关性有差异:小于阈值时,入院收缩压与院内死亡呈现明显负相关;而大于阈值时,入院收缩压与院内死亡未呈现明显相关性.在临床实践中应根据入院收缩压对心力衰竭患者进行准确的危险分层,制定个体化、规范化的干预方式.

目的 评价沙库巴曲/缬沙坦治疗老年女性射血分数保留心力衰竭患者的中期疗效.方法 连续性纳入2017年7月1日-2019年7月31日某院应用沙库巴曲/缬沙坦治疗≥60岁老年女性HFpEF患者86例作为研究组,按照1:3选择年龄和左室射血分数匹配、且应用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB)治疗的HFpEF患者129例作为对照组,随访截止时间为2020年7月31日,主要结局指标为不良心血管事件,包括死亡、因心力衰竭加重住院,次要结局指标为左心室射血分数、N末端B型利钠肽原和6分钟步行距离,安全性指标为症状性低血压.结果 258例患者中,平均年龄为(71.2±8.3)岁.两组的年龄、肾功能、血压、合并疾病、心功能和药物治疗等基线资料差异无统计学意义,P＞0.05.平均随访(22.5±11.6)个月.研究组的因心力衰竭再入院率23.3％比38％,P=0.035)和不良心血管事件发生率(27.9％比44.2％,P=0.027)均明显低于对照组,但两组的总病死率为7％比10.1％,心血管病死率为4.6％比6.2％,差异无统计学意义,P＞0.05.研究组的NT-proBNP较对照组显著降低,(304.5±183.2)pg/ml比(388.3±129.7)pg/ml,P=0.032;6MWT 显著增加(337.4±116.4)m 比(281.1±94.3)m,P=0.002,且心功能明显改善,P＜0.05;症状性低血压发生率高于对照组为10.2％比6.2％.多因素Logistic回归分析:年龄≥70岁(OR=1.824,95％CI:1.246～2.672,P=0.002)、肾小球滤过率＜60ml/min(OR=1.507,95％CI:1.116～2.042,P=0.007)、糖尿病(OR=2.317,95％CI:1.534～3.516,P=0.001)、NT-proBNP≥862.4pg/ml(OR=3.826,95％CI:1.107～13.328,P=0.035)是患者预后不良的危险因素,而沙库巴曲/缬沙坦(OR=0.767,95％CI:0.604～0.976,P=0.029)是保护因素.结论 沙库巴曲/缬沙坦能改善老年女性HFpEF患者的左心功能及运动耐力,并降低因心力衰竭加重再住院率和不良心血管事件发生风险.

Objective:To investigate the clinical effect of intra-aortic balloon pump(IABP)versus extracorporeal membrane oxygenation(ECMO)support for elderly acute fulminant myocarditis(AFM)patients combined with cardiogenic shock(CS).Methods:Clinical data of 12 elderly AFM patients with CS admitted to the Cardiac Intensive Care Unit of Beijing Anzhen hospital from January 2011 to December 2017 were retrospectively analyzed.Patients were divided into the IABP group(n=8)and the ECMO group(n=4). The differences in the medication treatment, use of temporary pacemaker, continuous renal replacement therapy and ventilation treatment, survival rates of at discharge and complications were analyzed and compared between the two groups.Results:Patients in the ECMO group had a lower left ventricular ejection fraction than those in the IABP group[(32.8±5.7)% vs.(42.2±7.8)%, t=2.122, P<0.05]. The percentage differences in patients receiving dobutamine(50.0% or 4/8 vs. 100.0% or 4/4), antibiotics(37.5% or 3/8 or 100.0% or 4/4)and polyene phosphatidylcholine(50.0% or 4/8 vs. 100.0% or 4/4)were statistically significant between the IABP and the ECMO groups( χ2=4.186, 5.716 and 4.186, P<0.05). There was no significant difference between the two groups in the time from admission to IABP or ECMO insertion(11.4±9.0)h vs.(8.3±6.5)h, support time(107.1±50.3)h vs.(140.5±65.0)h, receiving emergency extracorporeal cardiopulmonary resuscitation(ECPR)(37.5% or 3/8 vs. 75.0% or 3/4), survival rate at discharge(75.0% or 6/8 vs. 75.0% or 3/4)( P>0.05). The incidences differences between the two groups in complications including bleeding, lower limb ischemia and embolism, acute kidney injury, nervous system injury and multiple organ dysfunction syndrome were similar( P>0.05). The incidence of infection and the percentage of patients taking antibiotics were higher in the ECMO group than in the IABP group( P<0.05). Conclusions:Both IABP and ECMO can provide effective circulatory support for AFM patients combined with CS.Early use of ECMO is more effective than passive use.Complications occur more in ECMO therapy than in IABP therapy.

Objective:To evaluate changes in urinary neutrophil gelatinase-associated lipocalin(NGAL)levels in elderly coronary artery disease(CAD)patients after percutaneous coronary intervention(PCI), and to explore the role of NGAL and its value in the early diagnosis of contrast-induced nephropathy(CIN).Methods:This was a retrospective case-control study.A total of 68 patients undergone PCI were consecutively enrolled between October 2012 and October 2013.Serum creatinine(SCr)was measured before and at 24, 48 and 72h after PCI.Urinary NGAL was measured before and at 2, 12 and 24 h after PCI.The value of urinary NGAL for early diagnosis of CIN was analyzed.Results:The overall incidence of CIN was 8.82%.Urinary NGAL levels at 2 h, 12 h and 24 h after PCI were higher than pre-surgery levels(all P<0.05). Compared with the non-CIN group, urinary NGAL levels were increased in the CIN group at 2 h, 12 h and 24 h after PCI(all P<0.05). Pearson correlation analysis showed that urinary NGAL levels at 2 h, 12 h and 24 h after PCI were positively correlated with peak SCr within 72 h after PCI( r=0.625、0.493, and 0.226, all P<0.05), and were negatively correlated with peak eGFR within 72 h after PCI( r=-0.732、-0.603 and -0.449, all P<0.05). The area under the receiver operating characteristic(ROC)curve(AUC)showed that urinary NGAL was 0.740(95% CI: 0.481-0.998, P=0.029)at 2 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 62.5% and 73.3%, respectively, when the cut-off level was 17.52 ng/ml.The AUC of urinary NGAL was 0.948(95% CI: 0.895-1.001, P<0.001)at 12 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 87.7% and 88.3%, respectively, when the cut-off level was 44.30 ng/ml.The AUC of urinary NGAL was 0.931(95% CI: 0.869-0.994, P<0.001)at 24 h post-operation, and the sensitivity and specificity for the diagnosis of CIN were 86.2% and 73.3%, respectively, when the cut-off level was 48.65 ng/ml. Conclusions:Urinary NGAL can reflect acute kidney injury within 24 h of administration of contrast agents in coronary interventional therapy, and has a certain predictive value in the early diagnosis of CIN.

Objective To investigate the clinical values of intra-aortic balloon pump(IABP) and extracorporeal membrane oxygenation(ECMO) in acute fulminant myocarditis (AFM) patients with cardiogenic shock (CS).Methods Clinical data of 12 AFM patients with CS in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed from February 2011 to February 2017.The patients were divided into IABP group(n =8) and ECMO group (n =4).Baseline information,medication,uses of temporary pacemaker,continuous renal replacement therapy and mechanical ventilation,time between admission and mechanical circulatory support,supporting time,in-hospital prognosis and complications were analyzed.Results Left ventricular ejection fraction in ECMO group was lower than that in IABP group [(33 ± 6) ％ vs (42 ± 8) ％] (P =0.059).Gender,age,arrhythmia,left ventricular end-diastolic diameter,left ventricular end-systolic diameter,hemodynamics and laboratory indicators were similar between groups(all P ＞ 0.1).Use rate of antibiotics in ECMO group was higher than that in IABP group(3 vs 4,P =0.081).There was no significant difference of use rates of glucocorticoids,gamma globulin,positive inotropic agents,antiviral and hepatoprotective drugs,temporary pacemaker,continuous renal replacement therapy and mechanical ventilation between groups(all P ＞ 0.1).There were 4 cases in ECMO group and 3 cases in IABP group treated with invasive mechanical ventilation(P =0.081).Admission to mechanical circulation time and mechanical supporting time,rates of emergency extracorporeal cardiopulmonary resuscitation and in-hospital survival showed no significant difference between groups (all P ＞ 0.1).There were 3 cases of infection including 2 cases of pulmonary infection and 1 case of deep vein catheterization related infection in IABP group,and 4 cases of pulmonary infection in ECMO group,including 2 cases complicated with infection of puncture site;incidence of infection showed a significant difference between groups (P =0.081).There was no significant difference of complications such as hemorrhage,lower limb ischemia and embolism,acute renal injury,nervous system injury and multiple organ dysfunction syndrome between groups (P ＞ 0.1).Conclusions IABP and ECMO can provide effective circulation support for AFM with CS patients.Application of ECMO as early as possible is better than forced use.

Objective To observe the risk factors of in-hospital mortality in patients with acute myocardial infarction complicated with cardiogenic shock after primary percutaneous coronary intervention (PCI).Methods Totally 111 cases of acute myocardial infarction complicated with cardiogenic shock received acute PCI from 2009 to 2015 in Beijing Anzhen Hospital were enrolled.The cases were divided into the in-hospital death group (31 cases) and the in-hospital survival group (80 cases).The general information,clinical indicators,range of myocardial infarction,coronary lesions and management,complications,drug treatment and equipment assistance of the two groups were compared,and logistic regression analysis was used to analyze the risk factors of in-hospital mortality.Results The proportions of age ≥ 75 years,hyperlipidemia,serum creatinine ＞ 110 μmol/L,LVEF ＜ 40％,anterior myocardial infarction,three-vessel lesions of coronary artery,post-PCI TIMI flow grade ＜3,acute liver injury and acute kidney injury in the in-hospital death group were significantly higher than those in the in-hospital survival group (P ＜ 0.05).The proportion of IABP used in the in-hospital death group was significantly higher than that in the in-hospital survival group (P ＜ 0.05).There were no significant differences in the distribution of culprit lesion and the treatment of stenoses in nonculprit arteries between the two groups (P ＞ 0.05).Multivariate logistic regression analysis showed that age ≥ 75 years,threevessel coronary lesions,post-PCI TIMI flow grade ＜3 and acute renal injury were independent risk factors for hospital mortality (P ＜ 0.05).Conclusions Age ≥ 75 years,three-vessel lesions of coronary artery,post-PCI TIMI flow grade ＜3 and acute kidney injury were independent risk factors of in-hospital death in patients with acute myocardial infarction complicated with cardiogenic shock after primary PCI.

Objective To analyze clinical features of Takayasu's arteritis(TA) patients complicated with coronary artery lesions.Methods Four hundreds and seventy-four TA patients who were admitted in Beijing Anzhen Hospital,Capital Medical University from July 2003 to June 2015 were retrospectively analyzed;62 patients with coronary artery involvement were selected as observation group.One hundred and twenty-four patients with coronary atherosclerotic heart disease were selected as control group.Clinical data,erythrocyte sedimentation tate (ESR),C-reactive protein (CRP) and features of coronary artery lesions were analyzed.Results There were more female patients in observation group;there were less patients with hyperlipemia history,diabetes history,smoking and more patients with ESR ＞20 mrn/1 h and CRP ＞ 15 mg/L than those in control group[67.7％ (42/62) vs 23.6％ (28/124),17.7％ (11/62) vs 41.9％ (52/124),3.2％ (2/62) vs 26.6％ (33/124),4.8％ (3/62) vs 41.1％ (51/124),35.5％ (22/62) vs 3.2％ (4/124),46.7％ (29/62) vs 16.9％ (21/124)];the differences were significant (P ＜ 0.05).Cardiovascular symptoms had no significant differences between groups (P ＞ 0.05).Headache and pain of limbs [66.1％ (41/62)],hypodynamia [58.1％ (36/62)] and hypertension[56.1％ (35/62)] were common symptoms in patients with TA involving coronary artery.Left main coronary and coronary ostium involving rates in observation group were significantly higher than those in control group[8.5％ (12/142) vs 3.3％ (6/180),40.1％ (57/142) vs 7.2％ (13/180)] (P ＜ 0.01);proximal coronary artery and middle coronary artery involving rates in observation group were significantly lower than those in control group[18.3％ (26/142) vs 32.8％ (59/180),21.1％ (30/142) vs 35.6％ (64/180)] (P ＜ 0.05).Conclusion Takayasu arteritis complicated with coronary artery lesions is more common in female,left main coronary artery and coronary ostium.

临床医学专业学位研究生的培养包括临床思维、操作、沟通及科研能力等多方面内容,其中严谨科学的临床思维能力是成为合格医师所必备的.专业学位研究生在临床轮转期间因时间短、接触病种及病例数有限,现有教学查房、病例讨论等难以满足其提高临床思维能力的要求.由北京安贞医院心内科监护室主办的"心脏危重症交流平台"课程能够正确引导、培养及提高专业研究生的临床思维能力,有效弥补了现有培养方式的不足.

目的：探讨围绝经期女性血尿酸水平与冠心病及其冠脉病变程度的关系。方法分析617例行冠状动脉造影的围绝经期女性患者临床资料，依据造影结果分组，冠心病组359例，对照组258例。观察2组高血压病、2型糖尿病、高脂血症、及高尿酸血症与冠心病发病的关系。再根据冠脉病变支数分为单支病变、双支病变、多支病变3个亚组，将3个亚组的血尿酸水平分别进行比较。计算Gensini评分，分析血尿酸水平与冠脉狭窄程度之间的关系。结果冠心病组尿酸水平明显高于对照组，差异有统计学意义（ P ＜0 T．05）。 Logistic 回归分析显示，冠心病的独立相关危险因素为2型糖尿病、高尿酸血症、高胆固醇血症。冠脉单支、双支、三支病变组血尿酸水平呈递增趋势，但3组之间比较差异无统计学意义（ P ＞0．05）。血尿酸水平和冠脉病变狭窄积分无明显相关（ r ＝0．014， P ＞0．05）。结论高尿酸血症是围绝经期女性冠心病的危险因素，血尿酸水平与冠脉病变的支数及冠脉病变的程度无明显相关。

Objective:To compare efficacy and safety of Enoxaparin combined Tirofinban with Unfractionated heparin combined Tirofinban in the process of treating acute myocardial infarction.Methods: We enrolled on 256 consecutive patients admitted with AMI in our hospital.Patients were randomly divided into 129 of Enoxaparin group and 127of Unfractionated heparin group,both of them using Tirofiban,Aspirin and Clopidogrel treatment.To investigate the incidence in total deaths,cardiac death,recurrent myocardial infarction,stent thrombosis and other clinical events within 30d,and incidence in bleeding and platelet count in 72 hours.Results: Enoxaparin group had lower incidence of total deaths,cardiac death,recurrent myocardial infarction,stent thrombosis and other clinical events within 30d compared to Unfractionated heparin group,but no statistically significant difference(P0.05);Enoxaparin group had higher incidence in bleeding within 72 hours,but no statistically significant difference(P0.05).There was statistically significant difference(P0.05) in platelet count drop before and after treating with Enoxaparin group compared to Unfractionated heparin in 72 hours.Conclusion:Instead of unfractionated heparin,Enoxaparin is feasible for AMI patients combined Tirofiban.

Objective:To investigate prevalences and influential factors of depression in patients with acute coronary syndrome(ACS). Method:We collected 386 patients with ACS to evaluate the incidences of depression,gender,BMI educational background,type of health insurance,other diseases etc. Result:Among them,about 26.4% were identified as depression.Patients of ACS with depressive symptom were more universal in female(47.1% vs 26.8%),lower education background(59.8% vs 43.0%),medical reimbursement≤40%(47.1% vs 26.1%),BMI24 kg/m2(36.6% vs 19.1%) with history of diabetes(43.1% vs 26.1%) and EF50%(25.5% vs 11.6%).Multivariate Logistic regression analysis showed female(OR 2.42,95%CI 1.45-4.05,P=0.001),medical reimbursement ≤40%(OR 2.79,95%CI 1.67-4.68,P0.01),BMI24 kg/m2(OR 2.05,95%CI 1.19-3.52,P=0.01),with history of diabetes(OR 1.51,95%CI 1.16-1.95,P=0.002) and EF50%(OR 3.45,95%CI 1.81-6.60,P0.01) were impact factors on depression visibly. Conclusion:Impact factors of ACS include in female,medical reimbursement≤40%,BMI24 kg/m2,with history of diabetes and EF50%.

Objective:To investigate prevalences and influential factors of anxiety and depression in patients with acute myocardial infarction(AMI).Methods: We collected 214 patients with AMI that admitted in our hospital from January of 2011 to January of 2012.All the subjects were assessed with Hospital Anxiety and Depression Scale.To evaluate the incidences of anxiety and depression influencing factors such as age,gender,type of health insurance,other diseases etc.Results: Of all the subjects,about 34.1% were identifed as anxiety,29.4% as depression.The rate of the comorbidity of anxiety and depression was 23.4%.Patients of AMI with anxiety symptom were more seen in femal and medical reimbursement≤40%.Patients of AMI with depressive symptom were more seen in femal、medical reimbursement≤40% and with history of Diabetes.Multivariate logistic regression analysis showed female was the major influences of anxiety and depression.Medical reimbursement≤40%;with history of Diabetes were impact factors on depression visibly.Conclusion: There existed high prevalence of anxiety and depression disorders with AMI.And more importance should be paid on this phenomenon.

Objective To investigate prevalence and influential factors of depression in patients with acute coronary syndrome(ACS) and type 2 diabetes mellitus.Methods All 121 patients from January 2011 to January 2012 were collected.All the subjects were assessed with hospital anxiety and depression scale.The incidences of anxiety,depression and comparative analysis influencing factors were evaluated.Results Of 121 subjects,44 patients(36.4％)were identified as anxiety,45 patients (37.2％) as depression.The glycosylated hemoglobin of patients with depression disorders,the ratio of depression disorders patients with medical reimbursement ≤40％ and the ratio of depression disorders patients with left ventricular ejection fraction ＜ 50％ were higher than those of nondepression disorders patients [(7.9 ± 1.9) ％ vs (7.1 ± 1.8) ％,45.5 ％ (20/45) vs 20.8 (16/76),28.9％ (13/45) vs 7.9％ (6/76),P ＜ 0.05 or P ＜ 0.01].Patients of ACS and type 2 diabetes mellitus with depressive symptom were more seen in medical reimbursement≤40％,left ventricular ejection fraction ＜ 50％,and higher glycosylated hemoglobin patients[odds ratio (OR) 4.596,95％ confidence interval (CI) 1.806-11.698 ; OR 6.319,95％CI 1.831-21.810 ; OR 1.352,95％ CI 1.064-1.719,respectively; P ＜ 0.05 or P ＜ 0.01].Conclusions The incidence of depression disorders of patients with ACS and type 2 diabetes mellitus is high.Mental intervention should be taken early in order to improve prognosis.

Objective To observe the preventive effect of application of sodium chloride,sodium bicarbonate,sodium chloride plus N-acetylcysteine (NAC) and sodium bicarbonate plus NAC on contrast agent-induced nephrotoxicity (CIN) in patients undergoing coronary angiography and/or percutanceus coronary intervention ( PCI ).Methods All 627 cases of coronary angiography and/or PCI from October 2010 to October 2011 were randomly divided into four groups:sodium chloride group (n =161 ),sodium bicarbonate group (n =159),sodium chloride plus NAC group (n=157),sodium bicarbonate plus NAC group (n =150).All these patients used the low-osmolar nonionic contrast medium.The incidence of CIN were observed and analyzed.Results Of the 627 patients,28 experienced CIN,and the overall incidence was 4.47％ (28/627).CIN occurred in 4 patients (2.48％ )in the sodium chloride group,7 patients (4.40％) in the sodium bicarbonate group,8 patients (5.10％ ) in the sodium chloride plus NAC group and 9 patients (6.00％ ) in the sodium bicarbonate plus NAC group(P =0.483).Among diabetes complicated with renal insufficiency patients,CIN incidence was not statistically significant in four interventions groups (2/6,3/5,2/7,2/10 respectively,P =0.493).Conclusions Sodium chloride,sodium bicarbonate and NAC for reducing the incidence of CIN have no significant difference.In diabetes mellitus complicated with renal dysfunction,the efficacy of sodium bicarbonate plus NAC in preventing CIN is high but there is no significant difference among four groups.

Objective To study the risk factors of contrast-media induced nephropathy(CIN) in patients undergoing selective percutaneous coronary intervention(PCI) with routine hydration.Methods A total of 216 patients undergoing selective PCI from February 2010 to October 2011 were enrolled in this study,all patients were received infusion of saline [1.5 mL/(kg·h)] in preoperative period of PCI.Levels of serum creatinine were determined 24 hours before and 72 hours after PCI.Results Among the 216 patients,18 patients developed CIN(8.33%).The age,diabetic mellitus,decreased renal function,and contrast medium dosage in CIN patients were significantly different from those in non-CIN patients(P0.05 or P0.01).Identified by regression,age≥70,diabetes mellitus,preoperative eGFR60 mL/(min·1.73 m2) and volume of contrast medium were independent risk factors of CIN.Conclusions With routine hydration,incidence of CIN was 8.33% among patients undergoing selective PCI.Age,accompanied with diabetic mellitus,decreased renal function and contrast medium dosage are the independent risk factors,which should be highly alerted in high risk patients.

Objective:To study the influence of admission serum glucose(ASG) level on myocardial perfusion and short-term major adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI).Methods:Retrospectively analyze ASG level,clinical characteristics,coronary angiography results,and record the incidence of 30-day MACE in 298 patients with AMI from January 2009 to December 2011 of our hospital.Results:The proportion of cardiac Killip1 level,white cell numbers,Hs-CRP concentrations,CK and CK-MB levels were significantly increased in patients of ASG≥11.1mmol/L group(Group C),compared with those in patients in ASG of 7.8~11.1mmol/L(Group B) and ASG 7.8mmol/L(Group A)(P0.05).There was less frequently complete ST segment resolution and early T wave inversion in group C than those in group B and A after PCI(P0.05).There were more patients suffering from acute heart failure,recurrent non-fatal myocardial infarction,cardiac malignant arrhythmia and cardiac sudden death of MACE in group C than those in group A and B(P0.05).Conclusion:As the ASG level increased,myocardial perfusion levels in patients with AMI after PCI were decreased,and the incidence of 30-day MACE was increased.Therefore,strictly controlling ASG seems to be beneficial for improving myocardial perfusion and reducing short-term MACE.

Objective This prospective random control study was performed to compare the efficacy and safety of primary percutaneous coronary intervention(PCI) with sirolimus-eluting stent(Firebird) and paclitaxel-eluting stent(Coroflex) for acute ST-segment elevation myocardial infarction(STEMI). Methods Consecutive patients with STEMI who underwent primary PCI were randomly divided into Firebird group(n=112) and Coroflex group(n=108).The primary endpoints were major adverse cardiac events(MACE,including death,reinfarction and target vessel revascularization) within 12 months.The second endpoints included late luminal loss and restenosis at 9 months. Results The rate of in-stent restenosis of Firebird and Coroflex group was 4.8% vs 3.4%(P0.05),respectively.The late luminal loss of in-stent was(0.22±0.15) mm vs(0.23±0.17) mm(P0.05),respectively.There were no significant difference in death(2.7% vs 1.8%,P0.05),reinfarction(2.7% vs 1.8%,P0.05),target vessel revascularization(2.7% vs 2.8%,P0.05),MACE(4.5% vs 3.7%,P0.05) and stent thrombosis(2.7% vs 1.8%,P0.05) at 12 months between Firebird group and Coroflex group. Conclusion Firebird and Coroflex stents may have similar mid-term efficacy and safety in patients with STEMI treated with primary PCI.Further investigation is warranted to validate the long-term efficacy and safety.

Objective: To investigate the risk factors of contrast-induced nephropathy(CIN) in patients undergoing coronary angiography and/or percutaneous coronary intervention(PCI).Methods: 1 793 cases of coronary angiography and/or percutaneous coronary intervention(PCI) from January 2006 to October 2011 were enrolled in this study.The incidence of the risk factors of CIN were retrospectively analyze.All these patients used the low-osmolar,nonionic contrast medium.Results: Of the 1 793patients,140 experienced CIN,and the overall incidence was 7.81%.The incidence of CIN was increased with the increasing of the number of risk factors.The age,sex,diabetic mellitus,basic renal dysfunction,hydration treatment,with multi-vessel disease and contrast medium dosage in CIN patients were significantly different from those in non-CIN patients.Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN:age≥70 years,diabetes mellitus,preoperative eGFR60 mL/(min·1.73m2) and contrast volume150mL.Hydration is a protective factors,can reduce the incidence of CIN.Conclusion: The incidence of CIN was 7.81% among patients undergoing coronary angiography and/or percutaneous coronary intervention(PCI).The incidence of CIN was increased with the increasing of the number of risk factors.Age,accompanied with diabetic mellitus,renal dysfunction and contrast medium dosage are the risk factors.Hydration can reduce the incidence of CIN.

Objective To investigate the prevalence and influential factors of aspirin resistance in patients with coronary artery disease.Methods A total of 1731 patients with coronary artery diseases were evaluated for aspirin resistance with detection of optical platelet aggregation induced by arachidonic acid(AA)and adenosine diphosphate(ADP).Aspirin resistance(AR)was defined as a state in which aggregation of over 20% with 0.5 mmol/L AA and that over 70% with 10 μmol/L ADP was found.Aspirin semiresistance(ASR) was defined as meeting one of the above criteria.If both above criteria were not met,the condition was defined as aspirin sensitive(AS).The prevalence of AR among the study population and the influential factors associated with AR and ASR were analyzed.Results A 3.58% of the patients were AR and 20.34% were ASR.Among the AR+ASR group,female,elderly and hyperlipidemia patients were predominant,but less common in smokers.The platelet count and Cholesterol level were higher in the AR group than in the AS group.Logistic regression analysis showed that the risk of AR and ASR was female [odds ratio(OR)=1.377,95% confidence interval(CI) 1.084-1.751,P=0.009] and elderly(OR=1.504,95% CI 1.005-2.253,P=0.047).AR and ASR were more frequent in patients with hypercholesterolemia or thrombocytosis.Conclusion The risk factors of AR and ASR were female,elderly and hyperlipidemia.

Objective:To investigate the change of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in acute exacerbation chronic obstructive pulmonary disease (AECOPD) and AECOPD with heart failure.Method:The plasma NT-proBNP levels in 39 patients with AECOPD (12 with heart failure) and 15 heart failure patients without AECOPD were determined by enzyme linked immunosorbent assay (ELISA),and the arterial blood gas analysis and echocardiography were measured simultaneously.Result:NT-proBNP levels in AECOPD patients with heart failure were higher than those of AECOPD. (P0.001). NT-proBNP levels were significantly correlated with the left ventricular end-diastole and end-systole diameter as well as ejection fraction(r=0.471, 0.502 ,-0.522;P=0.003,0.002,0.001).Conclusion:NT-proBNP determination has a role in the early diagnosis of left heart failure in patients with AECOPD.