目的 探讨介入支架置入(percutaneous coronary intervention,PCI)术后4～6周实施乳腺癌手术的可行性和安全性.方法 2014年1月～2019年1月我们对18例乳腺癌合并重度冠状动脉狭窄先行PCI,PCI术后4～6周实施乳腺癌手术(3例完成PCI术后1个月确诊乳腺癌,15例乳腺癌术前准备发现冠状动脉重度狭窄,无法耐受手术及麻醉,先行冠状动脉PCI),重视围手术期管理,术前5 d开始停用阿司匹林及氯吡格雷,使用低分子肝素钙桥接抗凝,术中及术后使用心肌保护药物.结果 12例置入药物洗脱支架(drug eluting stent,DES),6例置入金属裸支架(bare metal stent,BMS).PCI术中支架置入后即刻血管造影显示血流通畅.乳腺癌手术包括改良根治术7例,乳腺全切术+前哨淋巴结活检4例,单纯乳房切除5例,保乳乳腺区段切除+前哨淋巴结活检2例,均顺利完成乳腺癌手术.手术时间50～145 min,(89.9±27.4)min;术中出血量30～200 ml,(98.3±59.5)ml.术中、术后血压、心率及血流动力学平稳,术前与术后3 d血小板、高敏C反应蛋白、脑钠肽、心肌肌钙蛋白Ⅰ及左心室射血分数差异无显著性(P>0.05),乳腺癌手术后无心脏相关事件发生.3例乳腺癌改良根治术后恢复抗凝后出现皮瓣下出血,通过加强负压引流及加压包扎控制,效果满意.住院时间5～8 d,(6.1±1.1)d.18例术后随访12～24个月,中位随访时间15个月,均无心脏相关事件发生,无肿瘤复发及转移.结论 通过加强围术期的管理,改善术中、术后心肌供血,选择恰当的手术方式,BMS与DES置入术后4周以上实施乳腺癌手术是安全的.

目的 分析CYP2C19基因多态性与经皮冠状动脉介入(PCI)术后氯吡格雷治疗患者血小板功能、炎性反应及病情转归的相关性.方法 选择2017年1—4月首都医科大学附属北京安贞医院心内科接受PCI及术后氯吡格雷、阿司匹林抗血小板治疗的冠心病患者204例作为研究对象,测定CYP2C19基因?2和?3等位基因缺失并进行分组,CYP2C19?1/?1为野生型(93例),CYP2C19?1/?2和CYP2C19?1/?3为杂合突变型(57例),CYP2C19?2/?2、CYP2C19?2/?3、CYP2C19?3/?3纯合突变型(54例).阿司匹林300 mg和氯吡格雷300 mg负荷24 h后,评价血小板抑制率及氯吡格雷抵抗率;治疗30 d后,测定血小板功能指标及炎性反应指标;治疗后1年内,随访严重心脏事件.结果 治疗30 d后,杂合突变型、纯合突变型患者CD62P、CD63、PAC-1、C反应蛋白(CRP)、CD40配体(CD40L)、可溶性细胞间黏附分子1(sICAM1)、白细胞介素-8(IL-8)、血栓形成速度(A)、最大振幅(MA)水平均高于野生型患者(F/P=78.971/0.000、70.594/0.000、50.581/0.000、22.413/0.000、46.681/0.000、37.623/0.000、13.007/0.000、3.557/0.000、21.394/0.000),凝血反应时间(R)、血细胞凝集块形成时间(K)短于野生型患者(F/P=13.428/0.000、9.669/0.000),且纯合突变型患者上述指标的变化较杂合突变型更为显著.杂合突变型、纯合突变型患者的血小板抑制率低于野生型患者(F/P=4.742/0.000),氯吡格雷抵抗率、治疗1年内严重心脏事件发生率高于野生型患者(χ2=10.901、6.700,P<0.05).结论 CYP2C19基因?2和?3等位基因突变能够加重血小板抵抗、促进血小板聚集、激活炎性反应.

Objective To investigate the preventive effect of ischemic postconditioning on non-culprit lesion progression in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention(PCI).Methods A total of 200 STEMI patients undergoing primary PCI from January 2010 to December 2013 in Beijing Anzhen Hospital,Capital Medical University were randomly divided into ischemic postconditioning group and eontrol group,with 100 cases in each group.Postoperative recovery,non-culprit lesion progression and related clinical indicators were analyzed.Results Secondary PCI rate of non-culprit lesion in 12 months after operation in ischemic postconditioning group was significantly lower than that in control group [7.0％ (7/100) vs 21.0％ (21/100)] (P ＜0.01).Seventy-nine patients did not have reoperation(group A) and 21 patients had secondary PCI (group B) in control group;93 patients did not have reoperation (group C) and 7 patients had secondary PCI (group D) in ischemic postconditioning group.Serum levels of adrenaline and noradrenaline in group B were significantly higher than those in group A;levels of adrenaline and noradrenaline in group D were significantly higher than those in group C(P ＜0.001).Types of non-culprit lesion showed no significant difference among group A,B,C and D (P ＞ 0.05).Serum levels of adrenaline,noradrenaline and C-reactive protein in patients without reoperation(n =172) were significantly lower than those in patients with secondary PCI (n =28) [(223 ± 48) ng/L vs (309 ± 52) ng/L,(1 807 ± 365) ng/L vs (2 528 ± 421) ng/L,(18 ± 6) mg/L vs (24± 8)mg/L] (P ＜0.001).Conclusions Revascularization after primary PCI is related to non-culprit lesion progression in patients with STEMI.Ischemic postconditioning may prevent non-culprit artery lesion progression.

Objective:To study expression of β-tubulin in non-infarction related coronary arteries and intervention mechanism of ramipril in rabbits.Methods:Myocardial ischemia-reperfusion model of rabbit was prepared,smooth muscle cells in non-infarction related arteries were divided into 4 groups(10 samples in each group) at random:① hyperlipidemia control group,②myocardium infarction group,③ myocardium infarction reperfusion group,④myocardium infarction reperfusion and ramipril invention group.immunohistochemistry analytical method was used to analysis for β-tubulin in non-infarction related arteries.Expression of β-tubulin in each group was analysised.Results:The thickness of atherosclerotic plaque in myocardium ischemia reperfusion group was more than that in myocardium ischemia group(113.61 ± 25.67) vs.(35.42 ± 11.19) μm(P ＜0.0001),the thickness of atherosclerotic plaque in myocardium infarction reperfusion and ramipril invention group was less than that in myocardium infarction reperfusion group(82.79 ± 17.24)vs.(113.61 ±25.67) μm,P ＜ 0.001),expression of β-tubulin in myocardium infarction reperfusion group was higher than that in myocardium infarction group,(413.61 ± 50.46) vs.(83.15 ± 21.1 2) (P ＜ 0.0001),expression of β-tubulin in myocardium infarction reperfusion and ramipril invention group was lower than that in myocardium infarction reperfusion group (312.79 ± 37.33) vs.(413.61 ± 50.46) (P ＜ 0.0001).Conclusion:Non-infarction related arteries may progress after primary PCI,it may be involved in β-tubulin,ramipril may inhibit progression of non-infarction related arteries by decreasing expression of β-tubulin.

Objective To investigate the incidence and risk factors of massive gastrointestinal hemorrhage (MGH) in the patients with coronary artery diseases treated with elective percutaneous coronary intervention ( PCI ) .Methods Consecutive 4239 patients with non-ST elevation acute coronary syndrome successfully treated with elective PCI in Anzhen Hospital from January 2012 to December 2014 were enrolled in this study .According to the occurrence of MGH or not within 1 year after PCI , the subjects were divided into MGH group ( n =47 ) and non-MGH group ( n =4192 ) .The clinical data , MGH events and mortality in 1 year of follow-up were compared between the 2 groups.Results The incidence of MGH was 1.11% (47/4239) in the subjects.The proportion of the patients with preoperative administration of warfarin and low-molecular-weight heparin was significantly higher in the MGH group than in the non-MGH group (P<0.05).Multivariate logistic regression analysis revealed that advanced age (>75 years, OR=1.25, P=0.031), anemia (OR=1.18, P=0.037), history of gastrointestinal hemorrhage (OR=1.49, P=0.005) and chronic renal insufficiency (OR=2.27, P=0.001) were independent predictors for MGH in the patients undergoing elective PCI .In 1 year’s follow-up, the mortality was obviously higher in the MGH group than in the non-MGH group (6.4%vs 3.2%, P<0.001). Conclusion Clinicians should adjust the type and dosage of antiplatelet drugs based on the patient ’ s age, body mass and renal function, and correct anemia and protect renal function to decrease the occurrence of MGH .

目的:分析血管造影诊断成人冠状动脉起源异常(AOCA)的检出率、分布规律,并总结本中心的手术经验.方法:回顾性分析我中心2013年全年的2 067例冠状动脉(冠脉)造影患者的临床资料及手术资料,并利用一种新型分型方案(LARAO分型)对AOCA的异常起源位置、手术相关参数进行分析.结果:2 067例冠脉造影检出19例AOCA,检出率为0.92％.其中,右冠脉起源异常12例(63.2％),是最为多见的起源异常类型;6例(31.6％)为左冠脉起源异常;1例患者左右冠脉开口均异常.与正常冠脉组相比,AOCA进行血管造影所需的导管数量、对比剂剂量及X线暴露时间均明显增加.采用LARAO分型发现,对侧冠脉开口周围(Ⅰ型,占26.3％)和升主动脉/对侧主动脉窦前壁(Ⅱ型,占68.4％)是AOCA的“热点”区域.在LARAO分型提出后,AOCA进行血管造影所需导管数量、对比剂剂量及X线暴露时间明显减少.结论:尽管成人AOCA的发生率极低,但会增加血管造影手术的难度,而LARAO分型有助于在血管造影术中寻找起源异常的冠脉.

Objective To explore the expression of connexin 43 (Cx43) in non-infarction related coronary arteries and the mechanism of angiotensin Ⅱ] (Ang]Ⅱ) in stimulating the expression of Cx43 in animal model of acute ST elevation myocardial infarction.Methods The hyperlipidemia model was prepared in rabbits and 8 of them were selected to establish the acute ST elevation myocardial ischemia reperfusion model (myocardial ischemia-reperfusion group) and another 8 of them were set as control group.One week after establishment of myocardial ischemia-reperfusion model,the fluorescence immunohistochemistry method was used to semiquantitatively measure the expression of Cx43 in non-infarction related arteries.The smooth muscle cells in non-infarction related arteries were isolated from normal and hyperlipidemia rabbits and were treated with different methods.Normal control group (12 sample):normal smooth muscle cells + phosphate buffer (PBS);hyperlipidemia control group (12 sample):hyperlipidemia smooth muscle cells + PBS;Ang Ⅱ intervention group (12 sample):hyperlipidemia smooth muscle cells + Ang Ⅱ (0.1 μmol/L,24 h);mitogen activated protein kinase (MAPK) signal transduction pathway inhibitor pretreatment + Ang Ⅱ intervention groups (12 sample):hyperlipidemia smooth muscle cells + PD98059 (100 μmol/L,30 min) or SP600125 (25 μmol/L,30 min) or SB203580 (25 μmol/L,30 min) + Ang Ⅱ (0.1 μmol/L,24 h).The expression of Cx43 was analyzed and compared among different groups.Results Atherosclerotic plaques were found in non-infarction related arteries in myocardial ischemiareperfusion group,and the expression of Cx43 in non-infarction related arteries was significantly increased compared with that in control group (absorbance value:2 136 ±238 vs 1 303 ± 142,P ＜0.05).The expression of Cx43 in Ang Ⅱ intervention group was significantly higher than that in hyperlipidemia control group and normal control group [(1.79 ±0.31) vs (1.25±0.21),(0.62 ±0.14),P＜0.05)];the expression of Cx43 in MAPK signal transduction pathway inhibitor pretreatment ± Ang Ⅱ intervention groups was all significantly lower than that in Ang Ⅱ] intervention group [(0.85 ± 0.19),(0.99 ± 0.13),(1.79 ± 0.31),(0.81 ± 0.15) vs (1.79 ± 0.31),P ＜ 0.05)].Conclusions Ang Ⅱ can stimulate the expression of Cx43 in non-infarction related arteries in acute ST elevation myocardial infarction through MAPK signal pathway.

目的:探讨一种新型的冠状动脉起源异常(AOCA)分型方法,以及对冠状动脉造影手术操作的指导作用.方法:LARAO分型方法是在X线二维透视下,采用左前斜和右前斜体位确定异常起源冠状动脉的开口位置,并将AOCA分为3型:1型为对侧冠状动脉开口周围型,Ⅱ型为升主动脉或对侧主动脉窦前壁型;Ⅲ型为其他型.采用LARAO分型对2013年我中心19例AOCA的起源位置、手术相关参数进行分析.结果:19例异常起源冠状动脉病例有5例LARAO Ⅰ型(26.3％),13例LARAO Ⅱ型(68.4％),而LARAO Ⅲ型仅有1例(0.53％).对侧冠状动脉开口周围和升主动脉/对侧主动脉窦前壁是AOCA的常见区域.Ⅰ型AOCA的理想导管是对侧造影导管,而大多数Ⅱ型患者(76.9％)最终选择AL导管完成手术.与采用LARAO分型之前的手术相比,这种分型可明显减少导管使用数量、对比剂剂量和X线曝光时间.结论:LARAO分型是一种适用于二维X线影像的新型分型方法,对AOCA的冠状动脉造影也有着良好的指导价值.

1病例资料患者,男,57岁,工人,主因"反复呼吸困难10年余"入院。患者10年前开始出现活动时呼吸困难,伴乏力,偶有夜间平卧受限,无胸痛及肩背部放射痛,无咳嗽及咳粉红色泡沫痰,无双下肢水肿,曾就诊于当地医院,诊断为"冠心病、心功能不全",给予阿司匹林片、美托洛尔、呋塞米等治疗,症状有所缓解。入院前1个月,患者上述症状加重,当地医

Objective To study the evolution of D-dimer in coronary artery reperfusion following AMI and its significance .Methods Eighty AMI patients admitted to our hospital from 2001 to 2010 were divided into group A (n=29) ,group B(n=30) ,and group C (n=21) .The therapeutic effect was assessed according to their coronary angiography .Serum D-dimer level was measured before and 1 ,2 ,4 ,8 ,24 ,48h after treatment .Serum CK-MB and troponin I levels were also meas-ured .Thrombogen time and thromboplastin time were recorded .Patients in group A received in-travenous thrombolysis treatment with recombinant tissue activator and those in groups B and C received intravenous normal saline drip .Results The serum CK-MB and troponin I levels were significantly higher in 3 groups following AMI .The serum D-dimer level was significantly higher ingroupAthaningroupCat 1,2,4,8h(4.31±0.94mg/L vs0.89±0.12mg/L,5.21±1.06 mg/Lvs1.55±0.43mg/L,7.56±1.53mg/Lvs0.93±0.12mg/L,4.33±0.99mg/Lvs0.61± 0 .17 mg/L ,P<0 .05 ,P<0 .01) ,in group B than in group C at 1 and 2 h (3 .69 ± 0 .86 mg/L vs 0.89 ± 0 .12 mg/L ,2 .39 ± 0 .66 mg/L vs 1 .55 ± 0 .43 mg/L ,P<0 .05 ,P<0 .01) ,and in group A than in group B at 2 ,4 ,8 ,24 h (P<0 .05 ,P<0 .01) .No significant difference in serum D-dimer level was found in group C at the same time points .Conclusion The serum D-dimer level is sig-nificantly different in AMI patients when they receive thrombolysis and autolysis treatment for coronary artery reperfusion ,and can thus be used as an indicator of thrombolysis .

目的 探讨入院血糖(APG)水平对老年急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PPCI)后无复流的影响.方法 入选712例STEMI成功行PPCI的老年患者,分为无复流组和复流正常组,收集患者的临床、冠状动脉造影和PCI资料评价无复流,采用多元logistic回归分析评价无复流的独立预测因素.结果 在712例老年患者中,发生无复流148例(20.8％).多元logistic回归分析结果显示,随着APG逐渐增加,无复流发生率也显著增加,APG为＜7.8 mmol/L、7.8～11.0 mmol/L、11.0～13.0 mmol/L和＞13.0 mmol/L时,无复流发生率分别为14.2％(26/183)、16.4％(48/292)、22.1％(19/86)和36.4％(55/151)(P=0.006).结论 入院血糖＞13.0 mmol/L是老年STEMI患者PPCI后无复流的独立预测因素.

Objective: To assess the no-reflow and its possible relationships with the SYNTAX(Synergy between percutaneous coronary intervention with Taxus and cardiac surgery) score(SXscore) and clinical characteristics in patients with ST-segment elevation myocardial infarction(STEMI) treated with primary percutaneous coronary intervention(PCI).Methods: In this study,397 patients with STEMI treated with PCI were analyzed retrospectively.The SXscore,thrombolysis in myocardial infarction(TIMI) flow grade score were determined in all patients.Patients were divided into two groups based upon the median SXscore.Angiographic no-reflow can be defined as a TIMI flow grade3.The association of SXscore obtained on diagnostic angiography during PCI with no reflow phenomenon after PCI was assessed by multivariate logistic regression.Results: The no reflow was found in 79 patients(19.9%) of 397 patients.The IRA more often had poor anterograde flow(TIMI grade 0 or 1) in patients with high SXscores.A multivariable logistic regression model revealed that variables strongly correlated with no-reflow were advanced age(≥55 years,odds ratio(OR) 2.46,95% confidence interval(CI) 1.72-3.41;P 0.001),administration of beta-blocker(OR 0.62,95%CI 0.41-0.92;P=0.021),Killip classes(4,OR 3.78,95% CI 2.14-6.48;P 0.001),time from pain to PCI(≥2h,OR 1.37,95% CI 1.02-1.79;P=0.036),and SXscore≥15.75(OR 1.16,95% CI 1.01-2.45;P 0.001).Conclusion: The SXscore obtained in the diagnostic phase of PCI can predict no-reflow after PCI in patients with STEMI.

目的 探讨老年女性急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PPCI)后无复流的独立预测因素.方法 入选320例STEMI并成功行PPCI的老年女性患者,分为无复流组和复流正常组,探讨PPCI后无复流的独立预测因素.结果 老年女性STEMI患者行PPCI后无复流发生率为25.3％(81/320).经单变量和多元logistic回归分析发现,收缩压(SBP)＜100 mm Hg、靶病变长度＞20 mm、侧支循环0～1级、PCI前血栓负荷评分≥4和PCI前IABP使用是女性STEMI患者PPCI后无复流的独立预测因素.无复流发生率随无复流预测因素数量增加而显著升高,具有0、1、2、3、4和5个无复流独立预测因素时无复流发生率分别为0％(0/2)、10.8％(9/84)、14.5％( 17/117)、37.7％ (29/77)、56.7％(17/30)和81.8％(9/11)(P＜0.01).结论 老年女性STEMI患者PPCI后无复流预测模型由5个因素组成:入院SBP＜100 mm Hg、靶病变长度＞20 mm、侧支循环0～1级、PCI前血栓负荷评分≥4和PCI前使用IABP.随着无复流独立预测因素增多,无复流发生率显著升高.

Objective To identify independent no-reflow predictors during primary percutaneous coronary intervention(PPCI) in female patients with ST-segment elevation acute myocardial infarction(STEMI) after various contemporary interventional strategies,thus to establish a model for predicting no-reflow status.Methods Totally 320 female patients with STEMI successfully treated with PPCI were divided into no-reflow group and normal reflow group.Results The no-reflow status was found in 81(25.3%) of 320 female patients.Univariate and multivariate logistic regression identified that low systolic blood pressure(SBP) on admission(<100 mm Hg,OR=1.991,95% CI: 1.018~3.896;P=0.004),target lesion length(>20 mm,OR=1.948,95% CI: 1.908~1.990;P=0.016),collateral circulation(0-1,OR=1.952,95% CI: 1.914~1.992;P=0.019),pre-PPCI thrombus score(≥4,OR=4.184,95% CI: 1.482~11.813;P=0.007),and intra-aortic balloon pulsation(IABP) use before PPCI(OR=1.949,95% CI: 1.168~3.253;P=0.011) were independent no-reflow predictors.The no-reflow incidence rate significantly increased as the numbers of independent predictors increased[0%(0/2),10.8%(9/84),14.5%(17/117),37.7%(29/77),56.7%(17/30),and 81.8%(9/11) in female patients with 0,1,2,3,4,and 5 independent predictors,respectively;P=0.000].Conclusion The 5 no-reflow predictor variables were low SBP on admission <100 mm Hg,target lesion length >20 mm,collateral circulation 0-1,pre-PPCI thrombus score ≥4,and IABP use before PPCI in female patients with STEMI and PPCI.The prediction model provides a basis for therapeutic decision making.

Objective It is to explore the application value of continuous blood purification(CBP) for critical patients with hypernatremia.Methods Twenty-one critical patients with hypernatremia in ICU were treated with CBP.We observed the changes of serum sodium concentration,serum osmolarity and the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores before and after CBP.Results The mortality rates was 62%(13/21),and the mortality of craniocerebral diseases with hypenatremia was 77%(10/13).The rate of moderate and severe hypernatremia in the death group was 69%(9/13),and the rate in survival group was 38%(3/8).Before CBP,the serum sodium concentration and APACHE Ⅱ scores were significantly higher in the death group than that in the survival group(P<0.01).Serum sodium concentration decreased 11.6 mmol/L per day and the rate of the serum sodium change was 0.88 mmol/L per hour.After CBP,the serum sodium and serum osmolarity decreased,and APACHE Ⅱ scores were improved in al1 patients(P<0.01).Conclusion The higher the serum sodium concentration and the longer the persistence time of high sodium concentration,the worse prognosis in critical patients with hypernatremia before CBP.CBP is safe and effective for critical patients with hypernatremia,and should be applied as quickly as possibly,especially in craniocerebral diseases with hypernatremia.

Objective To evaluate the effect of intracoronary tirofiban via both culprit artery and nonculprit artery,or via nonculprit artery on blood perfusion in percutaneous coronary intervention(PCI) for acute ST-elevation myocardial infarction.Methods A total of 100 cases of acute ST-elevation myocardial infarction(STEMI) were divided into experiment group(intracoronary tirofiban administrated via both culprit artery and nonculprit artery,and control group(intracoronary tirofiban administrated via culprit artery),with 50 cases in each group.The difference of corrected thrombolysis in myocardial infarction(TIMI) frame count(CTFC) and myocardial blush grade(MBG)F were compared before and after PCI between two groups.Results The rate of MBG Ⅱ to Ⅲ was higher in the experiment group than that in control group(P0.05),and serum cardiac troponin Ⅰ level was lower in the experiment group than that in control group(P0.05).There was no significant difference in CTFC between two groups(P0.05).Conclusion The effect of intracoronary tirofiban administrated via both culprit artery and nonculprit artery on blood perfusion is superior to intracoronary tirofiban administrated via only culprit artery in patients with acute ST-elevation myocardial infarction.

目的 评价入院血糖水平与ST段抬高型急性心肌梗死（AMI）患者急诊经皮冠状动脉（冠脉）介入治疗（PCI）后复流的相关性。方法 入选2007－2010年共1413例ST段抬高型AMI并在发病24h内成功进行急诊PCI的患者，分为无复流组和复流正常组，收集所有患者的临床、冠脉造影和PCI相关的资料以评价复流现象，采用多元回归方法评价无复流的独立预测因素。结果 1413例患者中发生无复流现象的患者为297例（21.0％），无复流患者入院血糖水平显著高于复流正常患者，多元回归分析发现吸烟、高脂血症、再灌注时间＞6h、入院肌酐清除率＜90ml/min、PCI前使用主动脉内气囊反搏和入院血糖水平＞13.0mmol/L是ST段抬高型AMI患者急诊PCI后无复流的独立预测因素。随着入院血糖水平的逐渐增加，无复流发生率也显著增加，血糖水平为＜7.8mmol/L和＞13.0mmol/L时，无复流发生率分别为14.6％和36.7％（P=0.009）。结论 入院血糖水平＞13.0mmol/L是ST段抬高型AMI患者急诊PCI后无复流的独立预测因素。

Objective To observe the function of recombinant human tissue factor pathway inhibitor1(rTFPI-1)in acute myocardial infarction in rabbit. Method Forty New Zealand White rabbits were subjected to coronary artery occlusion for 120 min and followed by reperfusion for 60 min,then they were ranlow dose rTFPI-1 group(n=10/group).The extent of ischemic area and the extent of myocardial infarction area were measured by Evan's blue stain and TTC stain,respectively.The degrees of infarction severity and ischemic severity were expressed as the ratios of the total left ventrieular wall area.The degrees of infarction severity and ischemic severity in different groups were compared by using one-way ANOVA and then followed by LSD procedure.Results The degree of infarction severity in the larger dose rTFPI-1 group was significantly lessened than that in low dose RTFPI-1 group and control group(P<0.001),and than that in modcrate dose rTFPI-1 group as well(P<0.05).The degree of infarction severity in the moderate dose rTFPI1 group was significantly lessened than that in low dose rTFPI-1 group and control group(P<0.001).There was no significant difference in degree of infarction severity between low dose rTFPI-1 group and control group(P>0.05).Conclusions Human rTFPI-1 might decrease myocardial infarction severity and save the survival myocardial tissue.

Objective To identify independent predictors of no-reflow after primary percutaneous coronary intervention (PPCI) in aged patients with ST-elevation acute myocardial infarction (STEMI), and thus construct a no-reflow predicting model.Methods Total of 668 aged patients with STEMI and successfully treated with PPCI were divided into the no-reflow group and the normal flow group. All clinical, angiographic and procedural data were collected. Multiple logistic regression analysis was used to identify independent no-reflow predictors.Results The no-reflow was found in 181 of 668 (27.1％) patients. Multiple stepwise logistic regression analysis identified that admission systolic blood pressure (SBP)＜100 mm Hg, collateral circulation 0-1 grade, pre-PCI thrombus score ≥ 4, and intra-aortic balloon pump (IABP) use before PCI were independent noreflow predictors. The no-reflow incidence significantly enhanced as the numbers of independent predictors increased [10.0％ (2/20), 13.7％ (32/233), 30.8％ (85/276), 38.1％ (37/97), and 59.5％ (25/42) in patients with 0, 1, 2, 3, and 4 independent predictors, respectively,x2 =25.796,P＜0.01) ]. Conclusions The no-reflow predictors are admission SBP ＜ 100 mm Hg, collateral circulation 0-1grade, pre-PCI thrombus score≥4, and IABP use before PCI in patients with STEMI and treated with PPCI. The prediction model may provide basis for therapeutic decision.

Objective To assess independent no-reflow predictors in patients with STEMI after primary drug-eluted stenting.Method A prospective study was carried out in 1413 patients with STEMI treated with primary drug-eluted stenting within 12 hours after onset of AMI from January 2007 through March 2010.The patients were divided into the no-reflow group and the normal reflow group.Univariate and multivariate logistic regression were applied to identification of no-reflow predictors.Results The no-reflow was found in 297(21.0％)of 1413 patients.Univariate and multivariate logistic regression identified that age ＞65 years,long time from onset to reperfusion ＞6 hours,admission plasma glucose(APG)＞ 13.0mmol/L,collateral circulation ≤ 1,pre-percutaneous coronary intervention(PCI)thrombus score ≥ 4,and intra-aortic balloon pump(IABP)used before PCI(P ＜0.05)were independent no-reflow predictors.The no-reflow rate significantly increased as the number of predictors increased(P ＜ 0.01).Conclusions There are 6 factors associated with coronary no-reflow used for prediction in patients with STEMI after primary drug-eluted stenting.