绝经后女性血雌二醇/睾酮值IL-6与冠状动脉狭窄程度的关系及对血管损伤的影响

目的 观察绝经后女性性激素、白细胞介素-6(IL-6)水平变化与冠状动脉狭窄程度的关系及支架植入术对其影响。方法 选择绝经2年以上初诊为冠心病并入院后行冠状动脉造影(CAG)的女性患者134例,按有无冠心病分为冠心病组(86例)及对照组(48例)。根据Gensini评分将冠心病组分为:冠心病A组(23例)﹑冠心病B组(36例)、冠心病C组(25例)。同时按支架植入与否分为:支架组(PCI组,50例),造影组(CAG组,36例)。检测并分析所有患者造影或支架植入前后血雌二醇(E₂)、睾酮(T)、IL-6水平。结果 ①冠心病组患者与对照组比较,E₂、E₂/T明显降低,IL-6显著升高,差异均有统计学意义(P<0.05);②随冠状动脉狭窄程度加重,冠心病A、B、C三组E₂/T值逐渐降低,IL-6水平逐渐增高,差异均有统计学意义(P<0.05);③支架植入组与造影组相比,IL-6水平升高,差异有统计学意义(P<0.05)。结论 绝经后女性冠状动脉狭窄严重程度与IL-6、E₂/T高度相关;血管损伤可诱发血IL-6水平快速升高;保持E₂/T的平衡可能有利于抑制冠状动脉的炎症活动。     

替罗非班对急性冠状动脉综合征患者经皮冠状动脉介入术后血浆可溶性OX40L的影响

目的:探讨替罗非班对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后血浆可溶性OX40L(sOX40L)水平的影响。方法:66例ACS患者设为ACS组,并根据治疗方法不同分为支架组和替罗非班组,支架组给予常规PCI介入治疗,替罗非班组给予PCI联合替罗非班治疗。另选择同期在我院疑似冠心病并经冠状动脉造影检查确认冠脉无狭窄者30例为对照组。测定术前1天、术后即刻及术后24h、48h、10d血浆sOX40L和超敏C反应蛋白(hs-CRP)水平。结果:术前ACS组血浆sOX40L和hs-CRP水平显著高于对照组(P<0.05);在ACS不同的临床类型中,心肌梗死(MI组)sOX40L和hs-CRP水平显著高于不稳定型心绞痛(UA组)(P<0.05);在不同的冠脉病变支数中,sOX40L和hs-CRP含量:三支病变组>双支病变组>单支病变组,各组间差异有统计学意义(P<0.05);术后即刻及术后24h、48h、10d替罗非班组sOX40L水平显著低于支架组(P<0.05);替罗非班治疗后无严重并发症发生。结论:ACS患者血浆sOX40L水平显著上升,且与冠状动脉粥样硬化病变的严重程度相关;替罗非班可降低ACS患者PCI后血浆sOX40L水平。     

冠脉造影及冠脉内支架术前后血浆肌钙蛋白I的变化

目的：研究及评估肌钙蛋白Ｉ（Ｔｎ１）对诊断冠脉内支架及冠造影相关的心肌损伤的作用,并与肌酸激酶同功酶（ＣＫ－ＭＢ）相比较。方法：连续测定１５例冠脉内支架术患者术前,术后,３０分,２４小时,４８小时血浆ＴｎＩ,ＣＫ－ＭＢ及２２例冠脉造影患者血浆ＴｎＩ及ＣＫ－ＭＢ动态变化。     

冠状动脉支架植入术后再狭窄的临床分析研究

目的探讨冠状动脉支架植入术后再狭窄的相关因素。方法 150例接受冠状动脉支架植入手术的患者分为Ⅰ、Ⅱ、Ⅲ三组,Ⅰ组98人,植入手术后再狭窄或病变的次数为0;Ⅱ组42人,植入手术后再狭窄或病变的次数≤1;Ⅲ组10人,植入手术后再狭窄或病变的次数≥2,对其进行临床分析,探讨支架植入术后再狭窄的相关因素。结果Ⅱ组、Ⅲ组患者2型糖尿病、支架长度〉20mm、支架直径〈3mm、C型病变、弥散病变、开口病变的患者比例显著高于Ⅰ组（P〈0.05）。Logistic回归分析结果发现,2型糖尿病,支架长度〉20mm,支架直径〈3mm,C型病变都是与冠状动脉支架植入术后再狭窄有关的影响因素。结论 2型糖尿病,支架长度〉20mm,支架直径〈3mm,C型病变都与冠状动脉支架植入术后再狭窄有关。     

Relationship between plasma osteopontin and oxidative stress in patients with coronary artery disease

Background: It is known that oxidative stress plays an important role in the pathogenesis of atherosclerosis and that an association exists between osteopontin (OPN) and atherosclerosis. Objectives: It was proposed that malondialdehyde (MDA), a biomarker of lipid peroxidation and oxidative stress, would be related to plasma OPN levels in patients with coronary artery disease (CAD). Methods/results: Plasma OPN and MDA levels were measured in 71 patients (60 males and 11 females; mean age 61.7 ± 10 years). Fifty-eight patients had significant CAD (group I) and 13 patients were free of CAD as defined angiographically (group II). Plasma OPN was measured by enzyme-linked immunosorbent assay (ELISA), while MDA was determined spectrophotometrically. Multivariate regression analysis revealed that ln-transformed OPN levels were independently associated with MDA after adjustment for age, hypertension and diabetes mellitus (R² = 0.278, p = 0.0004 and β regression coefficient = 0.252 [standard error = 0.0958], p = 0.011). OPN and MDA levels were higher in patients with diabetes (73.6 ± 36.2 ng/ml versus 56.1 ± 30.9 ng/ml, p = 0.02 and 2.5 ± 0.5 μM versus 2.0 ± 0.5 μM, p = 0.002, respectively). Conclusions: The association between OPN and MDA levels in patients with CAD suggests an interaction between OPN and oxidative stress. This interaction may play a role in the pathogenesis of atherosclerosis.     

Immediate removal of femoral-sheath following protamine administration in patients undergoing intracoronary paclitaxel-eluting-stent implantation

Background: Immediate sheath-removal using post-procedural reversal of heparin with protamine reduces groin complications, shortens bed rest and hospital stay after percutaneous coronary intervention (PCI) with bare-metal stents. No data are available with newer and possibly more thrombogenic paclitaxel-eluting stents (PES). Aim: We assessed the safety and efficacy of post-procedural protamine administration after successful coronary PES implantation in elective PCI and in patients with acute coronary syndromes (ACS). Methods: A consecutive series of 291 patients received 0.5 mg of protamine per 100 units of heparin whenever the post-procedural ACT was > 180 seconds, followed by immediate removal of the sheath (protamine group). Outcomes were compared to a historic control group comprising 291 consecutive patients, who also underwent PCI with PES, but without reversal of anticoagulation by protamine (non protamine group). The incidence of post-procedural vascular complications and bleeding complications, as well as hospital stay, were compared; as were the incidence of major cardiac events at 24 h, 30 days and 6 months. Results: The post-procedural bleeding complications were significantly higher in the non-protamine group. Vascular complications were also more frequent in patients who were not treated with protamine. Hospitalisation length was significantly lower in the protamine group than in the non-protamine group (13.6 ± 7 h versus 20.41 ± 3.9 h; p < 0.001). The protamine-group patients also had a significantly reduced bed rest (10.3 h ± 5.6 h versus 18 h ± 3.5 h; p < 0.001). During hospitalisation, after PES implantation, no deaths or acute stent thrombosis were observed in either group. The overall incidence of thrombosis and major adverse cardiac events at follow-up were similar in the two groups. Conclusions: Immediate heparin neutralisation by protamine after successful PES implantation appears to be safe and feasible, also in patients with ACS. Use of protamine and early sheath removal after PCI confers early deambulation and may significantly limit healthcare cost, reduce vascular complications, bedrest, delayed discharge and patient discomfort.     

Neointimal Hyperplasia Inhibition Effect of Angiotensin II Type 1 Receptor Blockers in Patients after Coronary Stent Implantation

Background and Objective

It remains unclear whether angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) can inhibit neointimal hyperplasia after stent implantation in patients with coronary artery disease. The aim of this meta-analysis was therefore to evaluate the benefits of ARBs in patients after coronary stent implantation based on the currently available randomized controlled trials.

Methods

We conducted a pooled analysis of randomized controlled trials to compare outcomes after stent implantation in patients administered ARBs with those not administered ARBs. We searched Ovid/MEDLINE, EMBASE, and the ISI web of knowledge using the terms ‘angiotensin receptor blocker,’ ‘renin angiotensin system inhibitor,’ ‘angiotensin receptor antagonist,’ ‘stent,’ ‘angiograph,’ ‘percutaneous coronary intervention (PCI),’ and ‘coronary artery disease.’ Published meta-analyses, review articles, and editorials were reviewed for potential studies of interest. The inclusion criteria were randomized controlled trials published in English, with a follow-up period of 6 months, comparing the outcomes after coronary stent implantation with and without the administration of any kind of ARB, reporting at least one outcome of interest (restenosis rate and late lumen loss). Data abstraction included study design, patient characteristics, follow-up period, type of ARB, type of stent, restenosis rate, and late lumen loss. Fixed-effects models were used to calculate the pooled relative risk for the restenosis rate and the standardized mean difference for late lumen loss.

Results

Five studies were included, with a total number of 624 patients. Seventy-five of 314 patients in the ARB group were diagnosed with in-stent restenosis at the 6-month follow-up, compared with 87 of 310 patients in the control group (relative risk 0.85; 95% CI 0.65, 1.11; p = 0.23). Consistent with this, there was no significant difference in late lumen loss between the two groups (0.04 mm; 95% CI ?0.15, 0.23; p = 0.66).

Conclusion

There is no evident benefit with the use of an ARB in terms of inhibition of neointimal hyperplasia in patients after coronary stent implantation.     

血清tPSA、fPSA和f／tPSA在前列腺癌合并冠状动脉支架置入患者中诊断作用的评价

目的 探讨冠状动脉支架置入患者血清总PSA（tPSA）、游离PSA（fPSA）和游离PSA/总PSA比值（f/tPSA）水平变化,以评价其在前列腺癌合并冠状动脉支架置入患者诊断中的价值.方法 对50例可疑冠心病男性患者行冠状动脉造影术,20例冠状动脉造影正常（组1）,30例患者行冠状动脉支架置入术（组2）.测定两组冠状动脉造影和支架置入前,后24 h和30 d时的tPSA、fPSA和f/tPSA值.结果 冠状动脉造影正常组患者（组1）tPSA、fPSA和f/tPSA值在冠状动脉造影术前后无显著性差异（P＞0.05）.冠状动脉支架置入术患者（组2）术后24小时tPSA、fPSA有显著性差异（P＜0.01）,而f/tPSA无显著性差异（P＞0.05）,术后30天tPSA、fPSA和f/tPSA值均无显著性差异（P＞0.05）.结论 冠状动脉置入术可引起tPSA、fPSA值明显升高,到术后30天时恢复正常范围.tPSA、fPSA值不能用于冠状动脉置入术后30天内前列腺癌的早期诊断.     

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

In the present study, we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α (HIF-1α) proteins before and after the coronary stent implantation. A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching (PSM) method. Of the 134 patients, 67 patients taking spironolactone were used as a test group, and the other 67 patients without taking spironolactone were used as a control group. In all patients, the levels of serum GATA4, HIF-1α, and troponin I proteins were determined before as well as 24 h and 6 months after the coronary stent implantation. Left ventricular ejection fraction (LVEF) and left ventricular systolic global longitudinal strain (GLS) were determined before and 6 months after the coronary stent implantation. There were no significant differences in the HIF-1α level between the two groups before and 6 months after the operation, while the HIF-1α level was significantly lower in the test group compared with the control group at 24 h after the operation (P < 0.01). There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation, while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation (P < 0.01). There was no significant difference in LVEF between the two groups before and 6 months after the operation. GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups, while GLS was significantly better in the test group compared with the control group at 6 months after the operation (P < 0.01). Collectively, spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.     

丹参多酚酸盐减少PCI相关性心肌梗死的初步研究

目的 观察丹参多酚酸盐减少经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）相关性心肌梗死的作用并研究其机制。方法 将心绞痛患者分为对照组和丹参多酚酸盐组,2组均给予心绞痛标准治疗。丹参多酚酸盐组在PCI术前和围术期静脉滴注丹参多酚酸盐。检测患者入院后第1天以及PCI术后24 h的肌钙蛋白I（cardiac troponin I,cTnI）,可溶性血栓调节蛋白（soluble thrombomodulin,sTM）、血管性血友病因子（von willebrand factor,vWF）的变化情况。观察2组患者的基线资料,以及PCI术后6个月的心血管事件和处理措施。结果 2组患者PCI术后均出现sTM、vWF、cTnI水平升高。丹参多酚酸盐组PCI术后的sTM、vWF显著低于对照组,差异有统计学意义（P<0.05）。丹参多酚酸盐组PCI相关性心肌梗死发生率低于对照组,差异有统计学意义（P<0.05）。丹参多酚酸盐组术后6个月心绞痛症状再发率低于对照组（P<0.05）。2组再次冠脉造影的差异无统计学意义,2组均未出现靶血管血运重建、非致死性心肌梗死、支架内血栓形成、心源性休克、猝死等不良心血管事件。结论 丹参多酚酸盐可能通过减少PCI术中血管内皮损伤,从而减少PCI相关性心肌梗死,改善患者预后。     

Evaluation of the effect of myocardial perfusion after percutaneous coronary intervention in coronary artery disease by using intracoronary myocardial contrast echocardiography and two other angiographic techniques

Detection of abnormal myocardial perfusion is crucial to the prognosis of patients with coronary artery disease (CAD) after they have undergone percutaneous coronary intervention (PCI). The objective of this study is to evaluate the effect of myocardial perfusion by three different methods—intra-coronary myocardial contrast echocardiography (ICMCE), corrected thrombolysis in myocardial infarction frame count (CTFC), and coronary blood flow velocity (BFV)—and to determine the value of these different methods in the evaluation of the effect of myocardial perfusion post-PCI. For the study sixty-eight patients were divided into four groups based on selective coronary angiography results: group A (normal coronary artery), group B (75%–95% coronary artery stenosis), group C (coronary artery stenosis >95%) and group D (acute total coronary occlusion). The effect of myocardial reperfusion was evaluated using the above mentioned three methods 15 min after PCI. IC-MCE was also performed before PCI in group D. The quantitative parameters of MCE involved: contrast peak intensity, time to peak intensity and area under the curve, representing myocardial blood volume, reperfusion velocity and myocardial blood flow, respectively. No difference was found in CTFC between the coronary artery stenosis group and the normal group. BFV was slower in group D than in group A(P < 0.05). The myocardial blood volume and the myocardial blood flow of the IC-MCE quantitative parameters were markedly lower in group C compared with those in group A (P < 0.05), and there were significant differences in the three MCE parameters between group D and group A (P < 0.05). For those patients with acute or total occlusion, the levels of myocardial perfusion before and after PCI were similar, as determined by IC-MCE and visually analyzed from 61 segments (P < 0.05). Quantitative IC-MCE evaluation of myocardial reperfusion is more accurate than with the other two methods. Moreover, with qualitative IC-MCE the level of myocardial reperfusion can be viewed directly and rapidly. Thus, the IC-MCE method is of great value to coronary artery disease (CAD) patients undergoing PCI, especially for those with acute myocardial infarction (AMI).     

稳定性心绞痛患者PCI围手术期血浆超敏C反应蛋白与血管再狭窄

目的：探讨超敏C反应蛋白（hs-CRP）在稳定性心绞痛患者PCI围手术期中的变化与术后再狭窄的关系。方法：分析78例稳定性心绞痛患者临床资料,分析其在PCI术前、术后即刻、术后24 h、术后72 h及复查冠脉造影前的超敏hs-CRP水平;术后6个月行冠脉造影复查后分为再狭窄组（10例）及无再狭窄组（68例）;比较两组hs-CRP水平。结果：再狭窄组与无再狭窄组比较,两组各项临床特征差异无统计学意义;PCI术后所有患者的hsCRP水平与术前相比均有明显升高,而且再狭窄组患者术后72 h hs-CRP水平高于无再狭窄组（9.81±4.76 vs6.64±2.89,P〈0.01）,术后24 h时再狭窄组hs-CRP水平高于无再狭窄组（3.77±1.52 vs 2.43±1.05,P〈0.05）。结论：稳定性心绞痛患者PCI术后24 h、72 h时hs-CRP明显增高时,提示患者可能出现支架内再狭窄。     

Effects of tirofiban on acute systemic inflammatory response in elective percutaneous coronary interventions

SUMMARY

Objective: In this study the effect of a specific glycoprotein IIb/IIIa inhibitor, tirofiban [which also has antiplatelet activity on acute systemic inflammatory responses (IR) during elective percutaneous coronary intervention (PCI)] was evaluated.

Patients and methods: Patients with stable angina pectoris and similar baseline characteristics who angiographically had a single lesion in their coronary arteries with a PCI performed on that lesion were enrolled in the study. One group of patients (control group, n?=?52) received 0.9% NaCl (15?mL/h for 24h) and the other group (tirofiban group, n?=?55) had tirofiban (10|ig/kg bolus infusion in 3min and 0.15jj,g/kg/mir for 24h) in addition to stenting without pre-dilatation. The effect of interventional procedure on levels of cardiac troponin T (cTnT) and several parameters of acute IR (leukocytes, fibrinogen, C-reactive protein, interleukin-1, interleukin-6, interleukin-8 and tumor necrotizing factor-α) was assessed on blood samples obtained from all patients before PCI and at pre-specified time points after PCI.

Results: During the follow-up after PCI, the number of patients becoming cTnT-positive (> 0.1?ng/mL) was greater in the control group [12 (23%) patients vs. 3 (5%) patients, p?=?0.01]. However, both groups had changes (generally observed as elevations) in their levels of all inflammatory parameters during the study and C-reactive protein, interleukin-6 and tumor necrotizing factor-α levels were elevated significantly. Yet, no significant difference occurred between groups due to these changes in any phase of the study (p?>?0.05).

Conclusions: Based on the findings of this study, it was concluded that although tirofiban limits development of myocardial necrosis during elective PCI, it does not directly affect the acute systemic inflammatory responses.     

冠状动脉支架置入术后血浆妊娠相关蛋白-A的变化研究

目的检测冠状动脉病变行经皮冠状动脉介入术(PCI)后血浆妊娠相关蛋白(PAPP)-A的变化。方法本研究选取140例稳定型心绞痛患者,随机分为对照组和冠状动脉支架置入组。对照组按常规行冠状动脉造影术,冠状动脉支架置入组择期行PCI置入支架。分别于术后即刻、1、3、24、72h测定血浆PAPP-A的水平,分析比较2组术后患者PAPP-A的差异。结果对照组与冠状动脉支架置入组患者手术即刻、1h的PAPP-A水平差异无统计学意义;冠状动脉支架置入组患者术后3、24、72hPAPP-A水平较对照组明显升高,差异有统计学意义(P<0.05)。结论PCI术后体内PAPP-A合成增加,24hPAPP-A的改变达到高峰,72h已出现下降。该结果对临床研究PAPP-A在PCI术中的意义及测定该指标的时间选择上有重要指导价值。     

PCI对急性冠脉综合征患者血浆脑钠素水平的影响

目的观察急性冠脉综合征患者PCI术后BNP水平短期内的变化。方法观察对象为72例急性冠脉综合征患者,其中急性心肌梗死48例,不稳定型心绞痛24例,7～10天后行PCI。49例经球囊预扩后置入支架,23例则直接支架置入,并测定术前、术后即刻、1h、3h、6h、12h的BNP水平。结果急性冠脉综合征患者PCI术后即刻BNP显著升高,3h达到高峰,12h渐恢复至基线水平。而49例球囊预扩后的BNP水平较直接支架置入术后有升高,P<0.01。结论急性冠脉综合征患者PCI术后BNP水平有一过性升高。     

高敏C反应蛋白结合血管内超声对冠心病临界病变介入术后心脏不良事件的评价

目的 探讨高敏C反应蛋白(hs-CRP)联合血管内超声(IVUS)检查对冠心病临界病变介入治疗术后患者主要心脏不良事件的评价作用.方法 82例临床诊断冠心病的患者,均于术前检测hs-CRP,经冠状动脉造影检查,明确至少有一支主要冠状动脉狭窄程度在40％ ～ 70％,所有患者均行血管内超声检查,明确最小管腔面积( MLA)≤4 mm2(非左主干)或≤6 mm2(左主干)后行支架植入,将患者分为hs-CRP升高组(≥3 mg/L)和hs-CRP正常组(＜3 mg/L),比较两组在住院期间和随访期间发生典型心绞痛、非致死性心肌梗死、心源性死亡和靶血管重建等主要心脏不良事件(MACE)的发生率.结果 hs-CRP升高组主要心脏事件发生率显著高于hs-CRP正常组(P ＜0.01);hs-CRP升高组再狭窄发生率高于hs-CRP正常组(P＜0.01).结论 hs-CRP能预测冠心病临界病变介入术后的心脏不良事件发生率,对hs-CRP升高的临界病变冠心病患者术后应强化抗血小板、抗炎等治疗.     

血流储备分数在指导冠状动脉分叉病变治疗策略中的作用

目的：评估左冠状动脉前降支支架植入后对第一对角支的影响,阐明血流储备分数（FFR）在指导冠状动脉分叉病变策略制订中的作用。方法纳入63例左冠状动脉前降支病变患者,冠状动脉左前降支（LAD）支架植入后,根据边支FFR值分为FFR＞0.80组（48例）及FFR≤0.80组（15例）。观察并记录患者一般临床特征及造影前血液学检查结果包括血常规、血糖、低密度脂蛋白、肾功能、尿酸等。结果两组患者经皮冠状动脉介入（PCI）术前LAD参考血管直径[（3.30＆#177;0.17）、（3.34＆#177;0.27）mm,P=0.882]、定量冠状动脉造影（QCA）直径狭窄百分比[（0.89＆#177;0.10）%、（0.88＆#177;0.12）%,P=0.934]、病变长度[（20.50＆#177;6.40）、（22.70＆#177;8.90）mm,P=0.765]、FFR均值（0.65＆#177;0.11、0.63＆#177;0.15,P=0.837）,LAD PCI后对角支参考血管直径[（2.62＆#177;0.17）、（2.63＆#177;0.19）mm,P=0.794]、QCA病变直径狭窄百分比[（0.47＆#177;0.24）%、（0.58＆#177;0.20）%,P=0.109]、最小管腔直径[（1.39＆#177;0.62）、（1.12＆#177;0.55）mm,P=0.141]比较,差异均无统计学意义（P＞0.05）;而LAD PCI后对角支FFR均值（0.91＆#177;0.05、0.69＆#177;0.04）比较,差异有统计学意义（P＜0.01）。前降支支架植入后,在对角支FFR＞0.80组,有16.7%（8/48）患者QCA直径狭窄大于或等于70.0%为假阳性;在对角支FFR≤0.80组,有66.7%（10/15）患者QCA直径狭窄小于70.0%为假阴性。结论 FFR在指导冠状动脉分叉病变治疗策略中具有重要意义,可显著降低分叉病变处理的复杂性。     

IABP辅助PCI治疗高危急性冠脉综合征的效果评估

目的 评价主动脉内球囊反搏术(IABP)辅助经皮冠状动脉介入(PCI)治疗高危急性冠脉综合征(ACS)患者的效果。方法 选取95例ACS合并血流动力学不稳定或心源性休克的高危患者并分为两组, 50例患者PCI前24 h内进行IABP治疗(IABP+PCI组), 45例直接PCI(PCI组)。在入院及PCI术后第5天分别检测N末端B型利钠肽原(NT-proBNP)和超敏C反应蛋白(hs-CRP)水平;入院时及出院后4周心脏彩超测定左心室射血分数(LVEF)。结果 治疗前两组收缩压均偏低, 两组差异无统计学意义(P>0.05)。治疗后, IABP+PCI组血压较PCI组血压明显升高(P<0.05);同时IABP+PCI组病死率有所下降(P<0.05), 住院天数减少 (P<0.05)。两组治疗前的血浆NT-proBNP 和 hs-CRP差异无统计学意义 (P>0.05), 治疗后IABP+PCI组血浆NT-proBNP 和 hs-CRP水平较PCI组明显下降(P<0.05), LVEF明显提高(P<0.05)。结论 IABP辅助PCI治疗高危ACS患者, 在一定程度上改善了血流动力学, 并使住院天数和短期病死率有所下降, 同时降低了血浆NT-proBNP 和 hs-CRP水平, 提高了LVEF。     

Trimetazidine Administration Minimizes Myocardial Damage and Improves Left Ventricular Function after Percutaneous Coronary Intervention

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate whether the administration of trimetazidine, a piperazine derivative, to patients before and after percutaneous coronary intervention (PCI) minimizes the PCI-induced myocardial damage and improves left ventricular function 1 and 3 months after the procedure. METHODS: Fifty-two patients hospitalized for acute coronary syndromes (ACS) were included in this study. Patients were randomized into two groups: group A (trimetazidine group; n = 27) and group B (placebo group; n = 25). All patients received conventional antianginal therapy. In addition, group A patients received oral trimetazidine 20 mg every 8 hours, starting 15 days before PCI and continuing for 3 months after the procedure. For each patient, serum troponin I and creatinine kinase (CK)-MB levels were measured before PCI, then at 6, 24, and 48 hours after the procedure; a 2D cardiac echocardiogram was performed before PCI and at 1 and 3 months after the procedure. RESULTS: Twenty-four hours after PCI, troponin I levels were >1 ng/mL in 7 of 27 patients (26%) of group A and 11 of 25 patients (44%) in group B. Fourty-eight hours after revascularization troponin levels remained elevated in 15% of patients in group A and in 32% of patients in group B. Twenty-two percent of patients in group A had CK-MB levels >5 ng/mL, 24 hours after PCI, compared with 40% of patients in group B; four patients of group A had high CK-MB levels prior to PCI procedure.Echocardiographic measurements before revascularization revealed that 11 of 27 patients (40%) in group A had an ejection fraction <50% versus 8 of 24 patients (33%) in group B . The number of patients with an ejection fraction <50% was significantly reduced in group A compared with group B at 1 and 3 months after PCI, i.e. 11% versus 16% (p = 0.046) at 1 month and 4% versus 16% (p = 0.017) at 3 months.A significant improvement in regional wall motion was noted after treatment with trimetazidine compared with placebo. One month after PCI, inferior left ventricular (LV) wall hypokinesia had improved in 4 of 6 trimetazidine recipients and in 4 of 14 placebo recipients (p = 0.014, group A vs group B). After 3 months inferior wall hypokinesia improved in four patients in group A versus six patients in group (p = 0.05). Similarly, anterior LV wall motion improved in 3 of 11 patients in group A and in 1 of 6 patients in group B at 1 month. After 3 months anterior wall hypokinesia had improved in eight patients in group A and in two patients in group B (p = 0.04, group A vs group B). CONCLUSION: The metabolic agent trimetazidine appears to minimize myocardial reperfusion injury during PCI and improves global and regional wall motion at 1 and 3 months after PCI. This study was limited by small patient numbers and further studies are necessary to evaluate exact mechanisms of action and clinical implications of using trimetazidine in conjunction with PCI.