Objectives To investigate the long-term outcome of patients with acute ST-segment elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery (IRA) and the risk factors for mortality. Methods The enrolled cohort comprised 323 patients with STEMI and multivessel diseases (MVD) that received a primary percutaneous coronary intervention between January 2008 and November 2013. The patients were divided into two groups: the CTO group (n = 97) and the non-CTO group (n = 236). The long-term major adverse cardiovascular and cerebrovascular events (MACCE) experienced by each group were compared. Results The rates of all-cause mortality and MACCE were significantly higher in the CTO group than they were in the non-CTO group. Cox regression analysis showed that an age ≥ 65 years (OR = 3.94, 95% CI: 1.47–10.56, P = 0.01), a CTO in a non-IRA(OR = 5.09, 95% CI: 1.79 ~ 14.54, P < 0.01), an in-hospital Killip class ≥ 3 (OR = 4.32, 95% CI: 1.71 ~ 10.95, P < 0.01), and the presence of renal insufficiency (OR = 5.32, 95% CI: 1.49 ~ 19.01, P = 0.01), stress ulcer with gastraintestinal bleeding (SUB) (OR = 6.36, 95% CI: (1.45 ~ 28.01, P = 0.01) were significantly related the 10-year mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 (OR = 2.97,95% CI:1.46 ~ 6.03, P < 0.01) and the presence of renal insufficiency (OR = 5.61, 95% CI: 1.19 ~ 26.39, P = 0.03) were significantly related to the 10-year mortality of patients with STEMI and a CTO. Conclusions The presence of a CTO in a non-IRA, an age ≥ 65 years, an in-hospital Killip class ≥ 3, and the presence of renal insufficiency, and SUB were independent risk predictors for the long-term mortality of patients with STEMI and MVD; an in-hospital Killip class ≥ 3 and renal insufficiency were independent risk predictors for the long-term mortality of patients with STEMI and a CTO.

Objective: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding. Methods: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors. Results: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86-9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07-7.04), indicated by multivariate logistic regression analysis. Conclusion: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.

Background: This study aims to analyze the in-hospital outcome of primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI) and prior coronary artery bypass grafting (CABG). Methods: This was a retrospective study. From January 2011 to December 2018, the data of 78 consecutive patients (study group) with prior CABG, who received primary coronary angiography in the setting of ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI), were screened. The study group was compared with another well-matched 78 patients without a history of CABG (control group). The information of the coronary angiograms and clinical data of both groups were analyzed. Multivariate conditional logistic regression models were constructed to test the association between PCI success rate and the prior CABG at age >_65 and <65 years, respectively. Results: The results revealed that the primary PCI success rate in the study group was significantly lower than in the control group (67.9% vs. 92.3%, P<0.001) and in-hospital mortality was significantly higher than in control group (11.5% vs. 2.5%, P=0.03). The multivariate logistic regression analysis indicated that the primary PCI success rate was significantly associated with the history of prior CABG both in young patients [age <65 years; odds ratio (OR) =5.26, 95% confidence interval (CI): 1.69-16.47] and elderly (age >_65 years; OR =13.76, 95% CI: 2.72-69.75). Conclusions: The patients who receive primary PCI with AMI and prior CABG have poor in-hospital outcomes, with low PCI success rates and high mortality.

1Heart Center & Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People’s Republic of China; 2School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China Objective: Patients presenting with acute myocardial infarction (AMI) with prior digestive system disease are more likely to suffer from gastrointestinal (GI) bleeding than those without these diseases. However, few articles reported how the different conditions of the digestive tract produced different risks of GI bleeding. Methods: A single-center study on 7464 patients admitted for AMI from December 2010 to June 2019 in the Beijing Chaoyang Heart Center was retrospectively examined. Patients with major GI bleeding (n = 165) were compared with patients without (n = 7299). Univariate and multivariate logistic regression models were constructed to test the association between GI bleeding and prior diseases of the digestive tract, including gastroesophageal reflux disease, chronic gastritis, peptic ulcer, hepatic function damage, diseases of the colon and rectum, and gastroenterological tract tumors. Results: Of the 7464 patients (mean age, 63.4; women, 25.6%; STEMI, 58.6%), 165 (2.2%) experienced major GI bleeding, and 1816 (24.3%) had a history of digestive system disease. The risk of GI bleeding was significantly associated with peptic ulcer (OR = 4.19, 95% CI: 1.86–9.45) and gastroenterological tumor (OR = 2.74, 95% CI: 1.07–7.04), indicated by multivariate logistic regression analysis. Conclusion: Preexisting peptic ulcers and gastroenterological tract tumors rather than other digestive system diseases were indicators of gastrointestinal bleeding in patients with AMI who undergo standard antithrombotic treatment during hospitalization.

目的 探讨影响急性心肌梗死(AMI)合并心原性休克(CS)患者住院期间死亡的因素.方法 回顾性分析2002年4月至2019年4月于首都医科大学附属北京朝阳医院心脏中心接受治疗的321例AMI合并CS患者的临床资料.将患者分为院内死亡组(230例)和院内生存组(91例).比较两组患者的基线特征、冠状动脉造影和介入治疗特征、心功能和生化指标.结果 与院内生存组相比,院内死亡组患者年龄偏大,院前时间偏长,非ST段抬高型心肌梗死比例偏高;三支冠状动脉病变发生率高,实施心肺复苏比例高,急诊经皮冠状动脉介入治疗(PCI)率偏低;血清肌酐和B型脑钠肽显著增高.两组主动脉内球囊反搏(IABP)置入率相当(82.3％比86.8％,P=0.349).两组左心室射血分数、肌钙蛋白I峰值、低密度脂蛋白胆固醇、白细胞计数、红细胞沉降率和C反应蛋白比较,差异均无统计学意义(均P>0.05).logistic多因素回归分析显示,年龄(OR 1.005,95％CI 0.992～1.212,P=0.047)、院前时间(OR 0.898,95％CI 0.991～1.006,P=0.048)、急诊PCI(OR 0.331,95％CI 0.103～3.521,P=0.039)和实施心肺复苏(OR 7.238,95％CI 1.620～32.343,P=0.010)是AMI合并CS住院期间死亡的独立预测因素.结论 IABP置入不影响AMI合并CS住院期间生存率.年龄、院前时间、急诊PCI和实施心肺复苏是住院期间死亡的独立预测因素.

Rationale: Acute myocardial infarction is a rare complication of carbon monoxide poisoning. there is often no chest pain and other typical manifestations. We report a patient with mild carbon monoxide poisoning who had acute dyspnea as the earliest symptom and was later diagnosed with non-ST elevation myocardial infarction (NSTEMI) and acute left heart failure. Patient concerns: A 73-year-old woman complained of dizziness and fatigue with shortness of breath after carbon monoxide intoxication. Diagnoses: This patient had a clear history of carbon monoxide poisoning, acute respiratory distress, bilateral lung dry and moist rale, chest X-ray showed bilateral pulmonary edema, Electrocardiograph indicated general depression of the ST segment of the leads in the chest, cardiac troponin I (CTNI) increased progressively, cardiac ultrasonography indicated abnormal ventricular wall movement, coronary angiography suggested left main trunk and 3-vessel lesions, suggesting diagnosis acute carbon monoxide poisoning, acute coronary syndrome, acute left heart failure. Interventions: She was treated with a high concentration of oxygen, an inhibitor of platelet aggregation (aspirin plus clopidogrel), an anticoagulant (low molecular weight heparin), an antimicrobial (ceftizoxime), an expectorant (mucosolvan), diuresis (furosemide and spironolactone), and myocardial support (Metoprolol). Coronary angiography and stent placement were performed 8 days later. Outcome: On the 10th day after onset of the condition, echocardiography was performed, which showed that cardiac function was improved. Mild segmental wall motion abnormality was observed on echocardiography. After 14 days, the patient had recovered well and was discharged without chest tightness, chest pain, dizziness, headache, or unresponsiveness. Lessons: This case suggests that the symptoms of carbon monoxide poisoning are complex and diverse. It can be manifested as a primary hypoxic symptom, or cause the exacerbation of underlying diseases due to hypoxia. Therefore, patients with carbon monoxide poisoning should actively seek comprehensive cardiac examination to ensure early diagnosis. Whenever necessary, coronary angiography and stent implantation should be performed to improve the likelihood of the patient's survival.

目的:比较住院期间经皮冠状动脉介入治疗(PCI)部分血运重建(IRA-only)和完全血运重建(CR)治疗急性ST段抬高型心肌梗死(STEMI)合并多支冠状动脉病变患者的远期预后.方法:回顾性分析2008年1月至2011年7月发病12 h内到达北京朝阳医院心脏中心并接受急诊PCI的592例合并多支冠状动脉病变的STEMI患者,在住院期间择期干预非罪犯血管为CR组(n=341),择期PCI平均延迟(5.2±2.2)天;未干预非罪犯病变的患者为IRA-only组(n=251).所有患者置入药物洗脱支架.比较两组患者远期预后,其中主要不良心脑血管事件(MACCE)包括全因死亡、再发心肌梗死、脑卒中以及再次冠状动脉血运重建.结果:两组临床基线特征相似,具备可比性.随访7～10年,平均随访(105.0±13.6)个月期间,CR组MACCE发生率与IRA-only组无显著差异(21.2％vs 26.0％,P=0.26),两组死亡、脑卒中及再发心肌梗死无显著差异,IRA-only组仅再次血运重建率显著高于CR组(21.5％vs 14.8％,OR=1.48,95％CI:1.01～2.18,P=0.04),主要表现在非罪犯血管再次血运重建率较高(14.6％vs 5.7％,OR=2.69,95％CI:1.54～4.69,P<0.001).结论:对于已经接受急诊PCI合并多支血管病变的STEMI患者,住院期间择期干预非罪犯病变血管未降低远期MACCE.

Objective To study the application of drug-coated balloon in treating the ostium lesions of LCX during percutaneous coronary intervention. Methods The 12 patients with the ostium lesions of LCX admitted to our hospital from October 2015 to July 2017 were included in this study.We use drug-coated balloon(DCB)to treat the LCX lesions during PCI, the patients underwent coronary angiography immediately after surgery and were followed up after 6 months of operation.10 patients(83.3%)underwent coronary angiography 6 months later.The MACE were recorded. Results The success rate of PCI was 100%.No complication occured during and after operation.There were no MACE events in the follow up, The minimal lumen diameters of the LCX increased from(0.31±0.12)mm before operation to(2.86±0.43)mm after operation(P<0.001). No MACE occurred in 6 months after operation; the coronary angiography 6 months later show there were no coronary restenosis in all cases.The diameters of the LCX were(2.93±0.39)mm. Conclusions Drug-coated balloon is safe and effective in treating the ostium lesions of LCX during PCI. Key words: Drug coated balloon; Coronary artery disease; Angioplasty, transluminal, percutaneous coronary

Percutaneous coronary intervention for patients with Coronary Heart Disease (CHD) accompanying End-Stage Renal Disease (ESRD) on hemodialysis therapy is complicated due to the presence of complex lesions and the associated severity of complications and high mortality rates. This study aimed to investigate the efficacy and safety and to simultaneously delineate optimal procedural algorithms and therapeutic strategies of PCI as the preferred revascularization approach in a limited population. A total of 18 patients with CHD accompanying ESRD on dialysis therapy who underwent PCI were analysed retrospectively. The procedural flowchart before and after PCI was described. The instant procedural success rate and peri- and post-procedural complications were analysed. Out-hospital follow-up data were also recorded. Twenty-eight PCI procedures were successfully performed in the 18 patients. The average number of stents was 2.2 ± 1.6 (1-6) per procedure, all of which were drug-eluting stents. Moderate to severe calcification in the coronary artery was found in 15 patients (83.3%), and rotational atherectomy was performed in four patients. The median follow-up duration was 18.9 (4-34) months. The degree of angina pectoris reduced in all patients, with no recurrence in 10 patients; the degree of angina pectoris reduced by one to two scales in eight patients after PCI. In-stent restenosis occurred in four patients (22.2%). One patient died after the fourth PCI procedure. PCI can be performed safely with high success rates in carefully selected patients with CHD accompanying ESRD on dialysis therapy and the symptoms would be alleviated effectively after optimizing procedural algorithms and therapeutic strategies.

Objective: To study the clinical outcomes of stent-thrombosis (ST) at different times in patients after drug-eluting stent (DES) implantation. <br> Methods: A total of 131 coronary angiography conifrmed ST patients in our hospital from 2005-01 to 2015-04 were studied. According to the time of ST occurrence, the patients were divided into 2 groups: Early ST group, ST occurred ≤30 days,n=42 and Late ST group, ST occurred >30 days,n=89. The in-hospital and follow-up information was collected; clinical outcomes were compared between 2 groups. <br> Results: The in-hospital MACE occurrence rate in Early ST group was higher than that in Late ST group (16.7% vs 4.5%),P=0.04. There were 123 patients survived to discharge and they were followed-up for the median of 38.00 (15.00, 62.00) months. Kaplan-Meier analysis estimated that the MACE-free survival was similar between 2 groups (41.9% vs 36.3%), P=0.43. <br> Conclusion: In-hospital MACE occurrence was higher in early ST patients, while the long term prognosis was similar between the early and late ST patients for whom with DES implantation.

目的 探讨药物洗脱支架(DES)术后发生支架内血栓(ST)的老年患者临床特点与预后.方法 入选经冠状动脉造影证实的DES术后发生ST患者132例,分为老年组(年龄≥60岁)64例和对照组(年龄＜60岁)68例.收集患者的临床资料,分析DES术后发生ST的老年患者临床特点与预后.结果 老年组住院期间主要不良心血管事件(MACE)发生率明显高于对照组(15.6％ vs 1.5％,P=0.004).Kaplan-Meier分析显示,老年组估算的无事件生存率明显低于对照组(33.2％ vs 44.6％,Plogrank=0.025).Cox多因素回归分析显示,年龄≥60岁(HR=2.19,P=0.022)和LVEF＜50％(HR=2.56,P=0.008)是总MACE的独立预测因素.结论 DES术后发生ST的老年患者近远期预后不良.

INTRODUCTIONAcute myocardial infarction (AMI) due to unprotected left main coronary artery (ULMCA) disease is clinically catastrophic although it has a low incidence. Studies on the long-term prognosis of these patients are rare.METHODSFrom January 1999 to September 2013, 55 patients whose infarct-related artery was the ULMCA were enrolled. Clinical, angiographic and interventional data was collected. Short-term and long-term clinical follow-up results as well as prognostic determinants during hospitalisation and follow-up were analysed.RESULTSCardiogenic shock (CS) occurred in 30 (54.5%) patients. During hospitalisation, 22 (40.0%) patients died. Multivariate logistic regression analysis showed that CS (odds ratio [OR] 5.86; p = 0.03), collateral circulation of Grade 2 or 3 (OR 0.14; p = 0.02) and final flow of thrombolysis in myocardial infarction (TIMI) Grade 3 (OR 0.05; p = 0.03) correlated with death during hospitalisation. 33 patients survived to discharge; another seven patients died during the follow-up period of 44.6 ± 31.3 (median 60, range 0.67-117.00) months. The overall mortality rate was 52.7% (n = 29). Kaplan-Meier analysis showed that the total cumulative survival rate was 30.7%. Cox multivariate regression analysis showed that CS during hospitalisation was the only predictor of overall mortality (hazard ratio 4.07, 95% confidence interval 1.40-11.83; p = 0.01).CONCLUSIONAMI caused by ULMCA lesions is complicated by high incidence of CS and mortality. CS, poor collateral blood flow and failure to restore final flow of TIMI Grade 3 correlated with death during hospitalisation. CS is the only predictor of long-term overall mortality.

Objective To explore the safety and feasibility of guiding catheter passing through spasmodic vessels in patients undergoing percutaneous coronary intervention (PCI) via radial artery access by the aid of PCI guiding wire and balloon .Methods The clinical data of 33 coronary artery disease (CAD) patients undergoing PCI via radial artery access with radial artery or (and) brachial artery spasm ( group A ) were retrospectively analyzed .Among all these patients , guiding catheters were delivered through the spasmodic vessels successfully by the aid of PCI guiding wires and balloons .The clinical data of other 38&nbsp;CAD patients having PCI during the same period performed by other operators via radial artery or ( and ) brachial artery approach and experienced vessel spasm were anlysed as the control ( group B ) .All patients in group B received conventional anti-spasm management during PCI .All vessel spasm was identified by angiography.For patients in group A , a diameter of 0.014 inch guiding wire was chosen to pass through the spasmodic vessel segment carefully and gently .The diameter of balloon should be chosen according to the diameter of guiding catheter .A balloon diameter of 2.0 mm and 2.5 mm was corresponded to 6F and 7F guiding catheter respectively .The balloon was advanced to the tip of guiding catheter , keeping a half in catheter and a half in vessel followed by inflating the balloon with a pressure of 8 atm.The balloon was kept inflated the guiding catheter was pushed in vitro carefully and slowly until the catheter passed through the spasmodic vessel segment .Then the balloon was deflated and pulled out together with PCI guiding wire . Exchanged a diameter of 0.035 inch wire and completed the positioning of guiding catheter .After finishing the PCI, radial or ( and) brachial angiography was performed again to observe if spasm disappeared and to determine if there any contrast medium exudation .For patients in group B , routine approach was applied including administration of nitroglycerine , diltiazem or nitroprusside etc . to relieve vessel spasm. Results The location of vessel spasm was similar in group A and group B ( P=0.150 ) , and the incidence rate of spasm in brachial artery was higher than that in radial artery in both groups .The chance of guiding catheter crossing the spasmodic vessel segment was significantly higher in group A than in group B ( 100%vs.39.5%, P=0.00).In patients whose guiding catheter could pass through the spasmodic vessel segment successfully , time spent in group A was shorter than in group B ( P=0.000 ) .The patient number which time spent was less than five minutes , five to 15 minutes and more than 15 minutes was 30 and 2 ( 90.1%vs.13.3%) , 3 and 7 ( 9.9% vs.46.7%) and 0 and 6 ( 0% vs.40.0%) in group A and in group B respectively.The incidence of forearm hematoma was lower in group A than in group B without statistical difference [6.1%(2/33) vs.18.4%(7/38), P =0.113].Conclusions It is safe and feasible for passing guiding catheter through spasmodic vessels during PCI via radial artery access by the aid of PCI guiding wire and balloon .

The article presented the training of interventional treatment of coronary heart disease in Beijing Chaoyang Hospital of Capital Medical University based on the particular teaching experience. The training was strengthened from four aspects of the professional clinical skills, cases teaching, lectures on evidence-based medicine and so on. After the training, all students who received training can do coronary angiography and PCI for simple lesion in accordance with the requirements of the syllabus, at the same time, improve medical ethics training and humanistic care, and finally achieved good educational results.

Objective To analyze the clinical characteristics and prognosis of the patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) due to unprotected left-main coronary artery (ULMCA) disease.Methods From January 1999 to May 2014,5 798 emergency coronary angiographies were performed.The AMI patients with infarction of related artery of ULMCA conformed by angiography were enrolled.Clinical characteristics and prognosis of the patients were studied.The patients were divided into two groups according to the occurrence of CS during hospitalization.The interventional data and outcome during short term and long term followed up were compared between the two groups.The causes of CS and mortality were analyzed.Results Fifty-eight patients were enrolled,and CS occurred in 31 patients (53.4％).Compared with CS free group,left ventricular ejection fraction,occurrence of TIMI grade 2-3 during diagnostic angiography,collateral circulation with Rentrop grade 2-3 and final flow of TIMI grade 3 were lower in the group with CS.Logistic analysis revealed poor collateral circulation (less than Rentrop grade 2) was related with occurrence of CS (OR =0.19,P =0.02).Twenty-three patients died in hospital,and the mortality in CS group was higher than that in the group without CS (64.5％ vs.11.1％,P ＜0.01).CS was confirmed as a powerful predictor of in-hospital mortality by Logistic analysis (OR =6.94,P =0.01).Long term follow up was performed in the 35 survivors with the duration of median time of 42.0 (12.0,60.0) months.The accumulative total survival rate was 20.3％ in patients with CS and 51.8％ in patients without CS (Log-rank,P ＜ 0.01).Multivariable COX regression analysis revealed the only independent predictor of total mortality during long-term follow up was CS during hospitalization (HR =4.67,P =0.004) . Conclusions AMI due to ULMCA disease was critically risky with high incidence of CS.The short term and long term prognosis of these patients with AMI caused by ULMCA disease complicated with CS was poor.

Background: Long-term outcomes of very late stent thrombosis (VLST) after implantation of drug-eluting stents (DES) are still unclear. The aim was to evaluate the long-term outcomes after VLST of DES, and to analyze the related factors of long-term outcomes in these patients.Methods: From January 2006 to February 2013, patients with angiographically defined VLST were studied. The clinical characteristics, angiography and interventional data, and anti-platelet therapy protocols were analyzed. The patients were divided into two groups according to the occurrence of major adverse cardiac events (MACE) during follow-up. The clinical and interventional data between the two groups were compared.Results: Sixty-two patients were enrolled consisting of 55 males and 7 females with an average age of 58.6 +/- 10.2 (41-82) years. The mean time from first implantation of DES to occurrence of VLST was 38.7 +/- 18.1 (12.5-84) months. One patient died in hospital. Sixty-one patients survived to discharge, and MACE occurred in 17 patients after a median follow-up of 32.1 +/- 19.1 (median: 44, range 5-88) months. The total MACE rate was 29.0% (18/62), and Kaplan-Meier survival analysis showed the estimated MACE-free survival was 45.1%. The rate of implantation of an additional first-generation DES during the first VLST in the group with events was higher (44.4% vs.11.4%, respectively, p = 0.007). The percentage of continuous dual antiplatelet therapy (DAPT) at the longest available follow-up was higher in the event-free group (27.8% vs. 75.0%, respectively, p = 0.001). Multivariable Cox regression analysis revealed that the only independent predictors for freedom of MACE during long-term follow-up was continuous DAPT at the longest available follow-up [hazard ratio (HR) = 0.30, 95% CI: 0.09-0.97, p = 0.04].Conclusions: Long-term outcomes after VLST were unfavorable. Implantation of an additional first-generation DES might be avoided, and DAPT should be continued. (C) 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

目的：对比不同药物治疗对于冠心病患者心室重构及 QT离散度的影响。方法冠心病患者80例根据随机抽签原则分为治疗组与对照组，每组40例，两组都给予介入治疗，介入前对照组给予美托洛尔治疗，治疗组给予螺内酯治疗，疗程为3个月。结果治疗组治疗后总有效率为97.5%，对照组为80.0%，治疗组明显高于对照组(P<0.05)。两组治疗后全血脑钠素含量、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、QT离散度较治疗前明显降低(P<0.05)，治疗后治疗组全血脑钠素含量、LVESD、LVEDD、QT离散度明显低于对照组(P<0.05)。结论相对于美托洛尔，螺内酯在冠心病患者中的应用能有效逆转心室重构状况，降低全血脑钠素含量，缩短 QT离散度，从而提高总体治疗疗效。

OBJECTIVE:To study the efficacy and safety of tirofiban in patients with acute non-ST- segment elevation myocardial infarction (NSTEMI) without early reperfusion intervention.METHODS:A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group (n = 76) and the control group(n = 75). Coronary angiography was performed at day 3 and day 7, while percutaneous coronary intervention (PCI) was performed when necessary. Parameters including thrombolysis in myocardial infarction (TIMI) flow, bleeding complications and clinic events within 30 days were compared between the two groups.RESULTS:Before PCI, no increase in the percentage of patient with TIMI flow better than TIMI-2 was observed by the treatment of tirofiban (69.3% vs 78.9%, P = 0.10). While after PCI, significant increase in the percentage of patient with TIMI flow better than TIMI-2 was manifested in the tirofiban group (96.0% vs 100.0%, P = 0.04). Tirofiban treatment also significantly decreased the rate of poor myocardial perfusion after PCI (19.7% vs 34.7%, P = 0.04). There were 0 and 4 major adverse cardiovascular events (MACE) within 30 days observed in the tirofiban group and the control group (0.0% vs 5.3%, P = 0.05). No difference between the two groups was found in the bleeding complications within 30 days including the mild hemorrhage (5 vs 4 cases, P = 0.75), severe hemorrhage (2 vs 1 cases, P = 0.56) or severe thrombocytopenia (2 vs 0 cases, P = 0.49).CONCLUSIONS:Tirofiban treatment does not increase the bleeding complications in NSTEMI patients without early PCI. Tirofiban can improve the TIMI flow and the myocardial perfusion after PCI with less MACE within 30 days.

BACKGROUND Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary. However, it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring. This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients. METHODS Acute coronary syndrome (ACS) patients (n = 384) who received high-risk, complex PCI were randomized into two groups. PCI in the two types of lesions described below was defined as high-risk, complex PCI: lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis. The patients in the conventionally treated group received standard dual antiplatelet therapy. The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping: If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d, for three months. The primary efficacy endpoint was a composite of myocardial infarction, emergency target vessel revascularization (eTVR), stent thrombosis, and death in six months. RESULTS This study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group, respectively. No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups. In the platelet function monitoring guided group, the mean IPA induced by AA and ADP were (69.2 ± 24.5)% (range, 4.8% to 100.0%) and (51.4 ± 29.8)% (range, 0.2% to 100.0%), respectively. The AA-induced IPA of forty-three (22.2%) patients was less than 50% and the ADP-induced IPA of fifty-seven (29.5%) patients was less than 30%; therefore, their drug dosages were adjusted. The TEG was rechecked one to four weeks after PCI, and the results indicated that the IPAs had significantly improved (P < 0.01). However, no significant differences were found in the rates of the primary efficacy endpoint. Rates in the conventionally treated group and platelet function monitoring guided group were 4.7% and 5.2%, respectively (hazard ratio: 1.13; P = 0.79). CONCLUSION An antiplatelet therapy guided by TEG monitored platelet function could not improve clinical efficacy even in ACS patients treated with high-risk complex PCI.

Systemic inflammation plays an important role in both chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD). The purpose of the present study was to assess the association of high‐sensitivity C‐reactive protein (hs‐CRP), a biomarker of systemic inflammation, with in‐hospital outcomes in patients with COPD undergoing percutaneous coronary intervention (PCI).