Impact of prolonged dual antiplatelet therapy on patients after drug-eluting stents implantation

Background Impact of dual antiplatelet therapy beyond 12 months on patients implanted with DES remains unsolved.Methods From January 2010 to June 2011,1873 patients who have been taking DAPT and free from death,myocardial infarction,stroke,repeat coronary revascularization,stent thrombosis,and major or minor bleeding according to TIMI criteria for 12 months after implantation of DES were randomly assigned to continuous (prolonged DAPT group) or discontinuous (standard DAPT group) clopidogrel (75 mg/day).The primary outcome was major adverse cardiovascular events (MACEs) which compose of death,nonfatal myocardial infarction (MI),nonfatal stroke,target vessel revascularization (TVR) or stent thrombosis (ST) at 180 days.Results There was no significant difference in the incidence of 180-day MACEs between prolonged DAPT group and standard DAPT group (8.98 % versus 10.13 %,respectively,P=0.400).The frequency of major bleeding was 0.64 % in prolonged DAPT arm and 0.43% in standard DAPT arm (P=0.523),that of minor bleeding was 3.32 % versus 2.87 % (P=0.585),respectively.Conclusions Prolonged DAPT beyond 12 months neither improve prognosis nor increase risk of bleeding in patients implanted with DES.     

Comparison of benefit and safety between different loading dose of clopidogrel on elderly patients undergoing primary percutaneous cronary intervention for ST-segment elevation myocardial infarction

Background Despite the proven benefit of 600-mg loading dose of clopidogrel in patients with acute ST-segment elevation myocardial infarction (STEMI) who undergo primary percutaneous cronary intervention (PCI), there is still concern about its benefit and safety on elderly population. Methods Data of 172 consecutive elderly patients (≥75 years) with STEMI who underwent primary PCI at Guangdong Provincial Cardiovascular Institute from January 2008 to December 2011 were retrospectively collected. Patients were divided into 600-mg loading clopidogrel group and 300-mg clopidogrel group accoring to the loading dose of clopidogrel before primary percunaeous coronary intervention(PCI). Enzymatic myocardial infarction size estimated by peak creatine kinase-myocardial band (CK-MB) and patency of the infarct-related artery (IRA) were compared. Thirty-day major adverse cardiac events (MACEs), which consist of death, nonfatal myocardial infarction (MI), nonfatal stroke, target vessel revascularization (TVR) or stent thrombosis (ST) were compared to assess the efficacy of different loading dose. Bleeding information was compared as well to assess the safety of different pretreatment stragety before primary PCI. Results 96 patients were adminstered with 600-mg loading clopidogrel before primary PCI while 76 were administered with 300-mg. Patency of the IRA was significantly higher in patients administered with 600-mg loading clopidogrel therapy as compared with those who received 300-mg loading clopidogrel (94.8% vs. 85.5%, P = 0.038). 600-mg loading dose of clopidogrel was associated with lower incidence of 30-day MACEs compared with 300-mg loading dose of clopidogrel (8.3% vs. 19.7%, P = 0.029) while did not increase the risk of TIMI major (3.1% vs. 3.9%, P = 0.770) and minor bleeding (10.4% vs. 6.6%, P = 0.376). Conclusion 600-mg loading clopidogrel improves final patency of the IRA and clinical outcome as compared with 300-mg loading clopidogrel without increasing bleeding hazard.     

高敏C反应蛋白与不稳定心绞痛行介入术预后的关系

目的　探讨低密度脂蛋白(LDL-C)正常的不稳定心绞痛患者超敏C-反应蛋白(hs-CRP) 浓度对经皮穿刺冠脉介入治疗(PCI)术后预后的影响。方法　不稳定心绞痛患者在PCI术前测定血清hs-CRP浓度，术后随访9个月，期间观察主要不良心血管事件（MACE）的发生率。结果　hs-CRP浓度正常组主要不良心血管事件发生率显著低于hs-CRP浓度增高组(P < 0.05)。结论 hs-CRP浓度水平与PCI术后主要不良心血管事件的发生有相关性，可作为PCI术后主要不良心血管事件的预测指标。     

酷似急性心肌梗死的病毒性心肌炎1例

1病例报告 患者女，51岁，因“咳嗽、气促1d，加重半天”于2006-12-30入院。入院前1周有头痛、发热，体温约38℃，伴全身酸痛、乏力，次日热退。4d前自觉头晕乏力，到外院就医，当时血压偏低（80／50mmHg，1mm Hg=0．133kPa）。2d前开始咳嗽，干咳无痰。入院前1日下午开始咳嗽加重并气促，坐位可缓解。     

阵发性睡眠性血红蛋白尿患者血细胞的特点及临床意义

目的 探讨阵发性睡眠性血红蛋白尿(PNH)患者血细胞的特点及临床意义。方法 对刚入院的33例PNH患者通过骨髓涂片或/和活检分成2组:骨髓增生活跃组21例,占64％;骨髓增生减低组12例,占36％。将2组患者的红细胞、血红蛋白、白细胞、血小板进行比较分析。结果 2组PNH患者的血红蛋白分别为(57.47±17.87)g/L和(71.30±19.52)g/L,红细胞分别为(1.58±0.49)×10~(12)/L和(2.15±0.59)×10~(12)/L,无明显差异(P>0.05);而白细胞分别为(6.14±4.21)×10~9/L和(2.34±0.90)×10~9/L,血小板分别为(110.29±89.06)×10~9/L和(23.42±12.06)×10~9/L,有明显差异(P<0.05)。结论 结果提示,PNH患者的血红蛋白和红细胞与骨髓增生情况似无明显相关的关系;白细胞、血小板与骨髓增生可能有关。     

肝硬化患者门静脉宽度与上消化道出血发生的相关性探讨

目的 探讨肝硬化患者门静脉宽度与上消化道出血发生的相关性。方法 通过B超对32例无上消化道出血肝硬化患者和30例有上消化道出血肝硬化患者进行门静脉宽度测定。结果 无上消化道出血组门静脉宽度平均为(14.37±1.33)mm,上消化道出血组门静脉宽度平均为(16.40±1.79)mm。两者统计学上有显著差异。结论 肝硬化患者门静脉宽度与上消化道出血有相关性。     

Diagnosis and management of coronary dissection and perforation in percutaneous coronary intervention

<正>With 20 years of instrumental progress and technical creativity, percutaneous coronary intervention (PCI) hasbecome one of the most important treatments for coronary artery disease. As PCI depends either on the mechanical dilatation of the artery or on the ablation     

阵发性睡眠性血红蛋白尿临床分析

目的提高对阵发性睡眠性血红蛋白尿(PNH)的诊治水平.方法分析了33例PNH临床资料,分为骨髓增生活跃(Ⅰ组)和增生减低(Ⅱ组)两组进行比较.结果 69.7%患者在20～40岁,两组均有不同程度的贫血,伴有出血、感染;两组PNH的血红蛋白、红细胞无差异(p>0.05),白细胞、血小板Ⅰ组高于Ⅱ组(p<0.05). 结论 PNH其贫血程度与骨髓增生程度无明显关系,而出血、感染与骨髓增生程度有明显关系,PNH是一种溶血性贫血,并总是与骨髓衰竭共存.     

阵发性睡眠性血红蛋白尿临床分析

目的　提高对阵发性睡眠性血红蛋白尿 (PNH)的诊治水平 .方法　分析了 3 3例PNH临床资料 ,分为骨髓增生活跃 (Ⅰ组 )和增生减低 (Ⅱ组 )两组进行比较 .结果　 69.7%患者在 2 0～ 40岁 ,两组均有不同程度的贫血 ,伴有出血、感染 ;两组PNH的血红蛋白、红细胞无差异 (p >0 .0 5 ) ,白细胞、血小板Ⅰ组高于Ⅱ组 (p <0 .0 5 ) .结论　PNH其贫血程度与骨髓增生程度无明显关系 ,而出血、感染与骨髓增生程度有明显关系 ,PNH是一种溶血性贫血 ,并总是与骨髓衰竭共存