非ST段抬高急性冠状动脉综合征患者妊娠相关血浆蛋白A水平与冠状动脉介入治疗预后的关系

目的探讨非ST段抬高急性冠状动脉(冠脉)综合征患者循环妊娠相关血浆蛋白A(PAPP-A)水平与经皮冠脉介入治疗(PCI)术预后的关系。方法检测86例单支冠脉病变的非ST段抬高急性冠脉综合征患者(不稳定型心绞痛58例,非ST段抬高急性心肌梗死28例)PCI术前PAPP-A和高敏C反应蛋白(hs-CRP)水平,考察其冠脉病变形态和术前术后罪犯血管供血区域的TIMI心肌灌注分级(TMPG),分析它们与术后随访1年内的主要心血管事件联合终点之间的关系。结果与无心血管事件患者比较,有心血管事件的患者术前hs-CRP水平较高(P=0.016),PAPP-A水平也明显升高[(28.55±20.21)mIU/L比(19.37±15.24)mIU/L,P=0.007],男性患者、高脂血症患者和有复杂病变的患者也较多。随访(9.7±3.0)个月期间,19例(22%)患者发生心血管事件;低PAPP-A的患者无心血管终点事件生存率较高(log rank=7.881,P=0.049),而PAPP-A≥15.41 mIU/L是强的联合终点事件预测因子(OR=2.23,95%CI:1.27～5.33,P=0.021)。结论 PAPP-A水平对单支血管病变的非ST段抬高急性冠脉综合征患者PCI术后的中期预后有预测作用。     

贫血对左心室射血分数保留型心力衰竭患者生存状况的影响

目的探讨贫血对射血分数保留型心力衰竭(HFPEF)患者预后生存状况的影响。方法选择在我院住院治疗的HFPEF患者325例,分为贫血组84例和无贫血组241例,收集临床资料,以全因死亡或心力衰竭再住院为终点事件,定期随访9~26(17.5±8.3)个月,用Kaplan-Meier生存曲线和Cox比例风险回归模型分析。结果贫血组终点事件发生率明显高于无贫血组(67.9%vs 48.1%,P=0.002)。贫血患者中位生存时间较无贫血患者明显降低(16个月vs 21个月,P=0.019)。贫血是影响预后的独立危险因素(OR=5.012,95%CI:3.271~6.160,P=0.006)。结论贫血是影响HFPEF患者预后的独立危险因素,在HFPEF患者诊治过程中应当予以高度重视。     

性别对80岁以上高龄急性冠脉综合征患者长期预后的影响

目的探讨性别对≥80岁高龄急性冠脉综合征(ACS)患者长期预后的影响。方法连续入选解放军总医院心内科自2006年1月至201 1年12月≥80岁行冠状动脉造影检查的ACS患者664例(女性占28.31%)。根据性别进行分组,对两组患者的临床资料结果进行比较分析,记录患者主要不良心脏事件(MACE),Kaplan-Meier生存曲线分析性别对高龄ACS患者长期生存率的影响。Cox多因素回归分析影响长期预后的独立危险因素。结果随访周期13~79个月(中位数28个月)。女性患者高脂血症患病率、左室射血分数、体质量指数及空腹血糖水平高于男性患者(P0.05)。男性患者舒张压、血尿酸水平、吸烟史、慢性肾功能不全、陈旧性心肌梗死、脑卒中发病率高于女性患者(P0.05)。两组患者的ACS临床分型、用药方案及治疗策略未见显著差异(P0.05)。Kaplan-Meier生存曲线分析显示,两组患者长期生存率(P=0.619)及无事件生存率(P=0.365)均无显著差异。Cox多因素回归分析显示非高密度脂蛋白胆固醇(non-HDL-C)、收缩压水平是高龄ACS患者全因死亡(HR=1.73,95%CI:1.09~2.75,P=0.019;HR=0.98,95%CI:0.97~1.00,P=0.015)和MACE发生(HR=1.80,95%CI:1.22~2.63,P=0.003;HR=0.98,95%CI:0.97~0.99,P=0.003)的独立危险因素。结论性别不是影响高龄ACS患者长期预后的危险因素,non-HDL-C和收缩压水平是该人群的全因死亡和MACE发生的独立危险因素。     

血浆内皮素1水平对稳定性冠心病患者的预后价值探讨

目的研究血浆内皮素1(big endothelin-1,ET-1)对稳定性冠心病(SCAD)远期预测价值。方法连续入选3154例SCAD患者,并随访24个月,随访期间,将发生心脑血管事件的189例为事件组,未发生心脑血管事件的2965例为非事件组。酶联免疫吸附法测定基线ET-1水平,将ET-10.3pmol/L为低ET-1组1588例,ET-1≥0.3pmol/L为高ET-1组1566例。应用Cox回归分析评价ET-1水平对终点事件的预测价值,应用Kaplan-Meier法绘制生存曲线。结果事件组ET-1水平较非事件组明显升高[0.33(0.25,0.49)pmol/L vs 0.30(0.22,0.45)pmol/L,P=0.004]。高ET-1组临床终点事件发生率明显高于低ET-1组(7.02%vs 4.97%,P=0.015)。多因素Cox回归分析显示,ET-1为临床终点事件的预测因素(HR=1.656,95%CI:1.099~2.496,P=0.016)。KaplanMeier分析显示,高ET-1组无事件生存率较低ET-1组降低(P=0.016)。结论 ET-1为SCAD患者预后的重要危险因素,其预后判断的长期作用有待进一步研究证实。     

残余血栓对右心功能不全的急性肺栓塞患者远期预后的影响

目的:分析合并右心功能不全(RVD)的急性肺血栓栓塞症(APE)患者的远期预后的影响因素。方法:入选2012年2月至2017年8月,于首都医科大学附属北京安贞医院急诊重症监护病房(EICU)收治的首次确诊APE伴RVD患者129例。抗凝治疗6～12个月通过肺通气/灌注显像(V/Q scan)评估是否存在残余血栓,分为残余血栓组及非残余血栓组。通过门诊或电话对纳入患者进行长期随访。研究终点包括全因死亡、复发和慢性血栓栓塞性肺动脉高压。通过Kaplan-Meier法描述患者终点事件的发生率,Log-rank检验生存率差异。Cox比例风险模型分析合并RVD的APE患者远期预后的影响因素。结果:共纳入129例患者,年龄25～85岁,平均年龄(63.3±13.3)岁,男性53例(41.1%),女性76例(58.9%),其中残余血栓组76例(58.9%),非残余血栓组53例(41.1%)。随访时间为(52.2±26.6)个月。据Kaplan-Meier法描述残余血栓组和非残余血栓组的总预后不良差异有统计学意义(P=0.009)。Cox单因素及多因素风险比例模型分析提示与预后不良相关的危险因素包括:无诱发因素(HR=3.325,95%CI:1.056～9.973,P=0.040)、残余血栓(HR=3.062,95%CI:1.035～9.061,P=0.043)。结论:残余血栓是合并RVD的APE患者预后的危险因素。     

甲状腺功能异常对老年非射血分数下降心力衰竭患者的心血管事件影响

目的探讨甲状腺功能异常对老年非射血分数下降心力衰竭(HFREF)患者的心血管事件影响。方法连续入选老年非HFREF患者579例,根据游离甲状腺功能三项水平分为甲状腺功能正常组(C1组)338例、亚临床甲状腺功能减退组(C2组)107例、亚临床甲状腺功能亢进组(C3组)31例及低三碘甲状腺原氨酸(T_3)综合征组(C4组)103例,随访1年,记录主要终点事件,包括心源性死亡和因心力衰竭发作再住院(再住院)。结果 4组因再住院率及病死率比较,差异有统计学意义(P0.01)。Cox多因素分析显示,促甲状腺素(TSH)10 mIU/L是心源性死亡(95%CI:1.555～14.401,P=0.006)和再住院(95%CI:1.394～4.851,P=0.003)的独立危险因素,单因素分析显示,C2组是心源性死亡和再住院的独立危险因素(95%CI:1.778～8.547,P=0.001;95%CI:1.333～2.901,P=0.001)。Kaplan-Meier生存曲线分析显示,以随访1年再住院为终点事件,C1组生存率明显高于C2组(P_(log-rank)=0.001),以心源性死亡为终点事件,C1组生存率明显高于C2组和C4组(P_(log-rank)0.01)。结论高水平的TSH对老年非HFREF患者更有利于判断长期预后价值。     

餐后低血压对高龄老年人远期预后的影响

目的研究餐后低血压(postprandial hypotension,PPH)对高龄老年人远期预后的影响。方法连续入选2011年5月1日～2012年10月30日解放军联勤保障部队第九二四医院干部病房住院的高龄PPH患者78例(PPH组),随机抽取高龄非PPH患者78例(对照组)。收集2组一般资料、颈动脉粥样硬化及斑块、心脏结构及功能等,进行7年随访,主要研究终点包括全因病死率、影响预后的心脑血管事件(包括急性心肌梗死、脑梗死和心源性猝死)发生率。采用Kaplan-Meier法、log-rank检验及Cox回归模型进行预后危险因素分析。结果 PPH组全因死亡、急性脑梗死比例明显高于对照组(51.3%vs 32.1%,P=0.015;35.9%vs 21.8%,P=0.017)。以全因死亡为结局,PPH组第1、3、5、7年累积生存率分别为96.2%、82.1%、62.8%、48.7%,对照组第1、3、5、7年累积生存率分别为100%、88.5%、74.4%、67.9%,2组生存时间比较,差异有统计学意义(P0.05)。以终点事件为结局,2组生存时间比较,差异无统计学意义(P0.05)。多因素Cox回归分析显示,升主动脉内径、室间隔厚度、LVEF以及早餐△收缩压是全因死亡的独立危险因素(RR=0.898,95%CI:0.828～0.974,P=0.010;RR=1.424,95%CI:1.109～1.829,P=0.006;RR=0.940,95%CI:0.905～0.977,P=0.002;RR=1.800,95%CI:1.306～2.482,P=0.000)。结论高龄PPH患者远期预后较非PPH患者差,全因病死率随着早餐后收缩压下降幅度的增加而增加。     

贫血和慢性肾脏病对高龄老年射血分数保留的心力衰竭患者预后影响的研究

目的 探讨贫血和慢性肾脏病(CKD)对高龄老年射血分数保留的心力衰竭(HFpEF)患者预后的影响。方法回顾性分析2016年1月至2023年3月解放军联勤保障部队第九六〇医院全科医学科收治的HFpEF高龄(年龄≥80岁)老年患者224例,根据患者入院时肾小球滤过率(eGFR)和血红蛋白水平分为非CKD+非贫血组88例、CKD组14例、贫血组79例和CKD+贫血组43例,按贫血程度将贫血组分为轻度贫血组67例和中重度贫血组12例,CKD+贫血组分为CKD+轻度贫血组31例、CKD+中度贫血组12例。以全因死亡、心血管死亡或至随访结束为随访终点,分析CKD和贫血与HFpEF患者预后的关系。结果 所有患者随访期间发生全因死亡100例(44.6%),心血管死亡32例(14.3%)。Kaplan-Meier生存曲线分析显示,CKD+贫血组的全因病死率和心血管病死率均高于非CKD+非贫血组、CKD组和贫血组(P<0.01)。Cox回归分析显示,CKD+中度贫血组全因死亡和心血管死亡风险显著高于非CKD+非贫血组(HR=6.43,95%CI:2.82～14.68,P=0.000;HR=10.63...     

老年急性ST段抬高型心肌梗死患者介入治疗后可溶性CD146水平的预后价值

目的 探讨老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后外周血可溶性CD146(sCD146)作为远期生存获益标志物的价值。方法 选取2021年1月至2022年7月于新疆喀什地区第二人民医院明确诊断为急性STEMI并行PCI的患者210例,根据PCI后外周血sCD146水平将患者分为低水平组69例,中水平组65例,高水平组76例。进行随访,终点事件包括全因死亡、心脏死亡和主要不良心血管事件(MACE)。采用Kaplan-Meier曲线比较各组累积生存率,采用Cox回归分析外周血sCD146水平与患者预后的关系。结果 高水平组发生死亡和MACE比例显著高于低水平组和中水平组(P<0.05)。Kaplan-Meier曲线分析显示,高水平组累积生存率显著低于低水平组和中水平组(P<0.05)。Cox回归分析显示,PCI后外周血sCD146水平与患者PCI后发生死亡独立相关(OR=1.530,95%CI:1.144～2.044,P=0.004)。结论 急性STEMI患者PCI后外周血sCD146水平与远期生存获益密切关联,sCD146可作为评估患者远...     

残余SYNTAX积分对急性冠脉综合征患者介入治疗后远期临床结局的预测价值

目的分析残余SYNTAX积分对急性冠脉综合征患者介入治疗后远期临床结局的预测价值。方法本研究为回顾性观察研究,连续纳入自2008年1月至2013年12月于冀中能源峰峰集团总医院行介入治疗的1 191例急性冠脉综合征患者。根据残余SYNTAX积分(residual SYNTAX score,rSS)结果分为3组:低rSS组、中rSS组、高rSS组。我们对患者的基线资料、介入治疗资料以及两年的随访结果进行比较。结果高rSS组的死亡加心肌梗死的复合终点发生率明显高于低rSS组和中rSS组,差异有统计学意义(P0.05)。3组之间血运重建发生率逐步增高(9.2%vs.19.6%vs.23.8%),联合事件终点的发生率也逐步增加(14.5%vs.23.8%vs.31.5%),差异均有统计学意义(P0.05)。Kaplan-Meier生存曲线显示3组之间随着rSS的增加,联合事件终点发生率明显增加(P=0.000)。多因素Cox分析表明残余SYNTAX积分是影响远期预后的独立危险因素,其他独立影响远期预后的因素包括高脂血症,介入治疗成功和应用糖蛋白Ⅱb/Ⅲa受体拮抗剂。结论 rSS可以量化介入治疗后的残余狭窄程度,而且是影响急性冠脉综合征患者介入治疗后远期预后的独立预测因素,随着rSS的增加,联合事件终点的发生率也逐步增加。     

Risk analysis of preoperative anemia in type B aortic dissection after thoracic endovascular aortic repair

Background Postoperative death of thoracic endovascular aortic repair(TEVAR) occurred in patients with type B aortic dissection(TBAD). The prognostic value of anemia, an important problem during the perioperative period, is unknown. Methods According to predefined criteria, 184 TBAD patients underwent TEVAR were divided into two groups: non-anemia group and anemia group. Clinical data were compared between groups and multiple Cox proportional hazard regression analyses were performed to detect the risk factors of long-term mortality. Results After median 2.5 years follow-up, 21 patients died. Long-term mortality was significant higher in patients with anemia(23.9% vs. 8.1%, P=0.006). Multivariate analyses showed that anemia was independently associated with increased risk of long-term mortality(HR=3.21, 95%CI: 1.31-7.89, P=0.011). The ROC curve showed that hemoglobin level had predictive role for long-term mortality(AUC=0.742, P0.001). The optimal cut-off was 130.2 g/L, with sensitivity and specificity being 85.7% and 52.0%, respectively. Conclusions Admission anemia was independently associated with increased risk of long-term post-TEAVR mortality in TBAD patients. Pre-TEAVR hemoglobin measure could be a risk assessment tool for TBAD patients undergoing TEAVR.     

替罗非班对急性STEMI患者安全性及近期预后的影响

目的探讨替罗非班辅助急诊冠状动脉介入(PCI)治疗ST段抬高心肌梗死(STEMI)患者的安全性及近期预后。方法选择2008年12月至2012年6月行急诊PCI治疗的STEMI患者468例,根据是否使用替罗非班,分为替罗非班组(n=351)和对照组(n=117)。采用Kaplan-Meier和Cox比例风险模型分析两组患者住院期间安全性指标(严重出血、轻微出血、血小板减少症)、术后30天和90天术后主要不良心血管事件(死亡、再梗死、靶血管血运重建)发生情况。结果替罗非班组住院期间安全性指标与对照组相比无统计学差异(P0.05)。替罗非班组30天(7.98%vs.16.24%,P=0.01)及90天(8.55%vs.19.66%,P=0.001)主要不良心血管事件(MACE)发生率均低于对照组。Kaplan-Meier生存分析显示,替罗非班组术后30天(Log Rank=7.977,P=0.005)及90天(Log Rank=12.371,P0.001)无MACE生存率显著高于对照组。Cox比例风险模型显示替罗非班使用可以减少术后30天(HR=0.443,95%CI:0.247~0793,P=0.006)MACE发生和90天(HR=0.391,95%CI:0.227~0.674,P=0.001)MACE发生的风险。结论替罗非班可改善经直接PCI治疗的STEMI患者短期临床预后,且安全性良好。     

Does anemia affect outcome after lobectomy or pneumonectomy in early stage lung cancer patients who have not received neo-adjuvant treatment?

BACKGROUND: Preoperative anemia has been shown to be an ominous prognostic factor for survival in patients with early stage non small cell lung cancer. METHODS: Two hundred and fourteen patients underwent resection for early stage non small cell lung cancer between 2001 and 2006 without neo-adjuvant treatment. Patients were divided into four groups based on their admission hemoglobin (Hgb): group I: Hgb < or = 12 g/dl, group II: Hgb = 12.1 - 12.9 g/dl, group III: Hgb = 13.0 - 14.0 g/dl, and group IV: Hgb > 14 g/dl. Cox regression analysis was used to evaluate each variable's impact on midterm survival taking all causes and lung cancer-specific mortality into account. Kaplan-Meier survival plots were estimated. RESULTS: Preoperative hemoglobin (HR = 1.44, 95 % confidence intervals 1.08 - 1.94, P = 0.014) and pneumonectomy (HR = 3.58, 95 % confidence intervals 1.26 - 10.16, P = 0.017) were the only predictors of all-cause midterm mortality. Similarly, when only lung cancer-related mortality was considered, preoperative hemoglobin (HR = 1.81, 95 % confidence intervals 1.17 - 2.78, P = 0.007) and pneumonectomy (HR = 6.89, 95 % confidence intervals 2.29 - 20.73, P = 0.001,) were independent predictors. Age, gender, pulmonary function test results, tumor stage, and histology did not influence survival. CONCLUSIONS: Preoperative anemia and the type of resection in early stage non small cell lung cancer have an impact on midterm survival and lung cancer-specific mortality.     

非酒精性脂肪性肝病患者血红蛋白水平变化及其临床意义

目的 探讨血红蛋白升高与非酒精性脂肪性肝病(NAFLD)发生风险的相关性。方法 利用1995年～1996年宝钢职工体检资料,收集血糖、血脂和血红蛋白等指标,对6540例无脂肪肝人群随访6年,分析基线血红蛋白水平与NAFLD发生风险之间的相关性。结果 在随访过程中,106例基线贫血患者新发NAFLD 2例(1.9%),5884例基线血红蛋白正常者新发645例(11.0%),550例基线血红蛋白升高患者新发116例(21.1%);Cox单因素回归分析结果显示不同血红蛋白水平者NAFLD发生率不同(血红蛋白升高组与贫血组比,HR=11.18,95% CI:2.76～45.23,P=0.001;血红蛋白正常组与贫血组比,HR=5.81,95% CI:1.45～23.28,P=0.013);经Cox多因素回归分析结果显示男性(HR=1.465,95% CI:1.114～1.928,P=0.006)、体质指数(HR=1.298,95% CI:1.259～1.320,P<0.001)、高甘油三酯血症(HR=1.781,95% CI:1.533～2.068,P<0.001)和血红蛋白水平(HR=1.008,95% CI:1.002～1.015 P=0.014)是影响NAFLD发生的独立危险因素。结论 血红蛋白升高与NAFLD发病相关,早期筛查Hb有助于风险提示,其相关机制值得进一步研究。     

主动脉球囊反搏在老年急性冠状动脉综合征中的应用及对预后的影响

目的探讨主动脉球囊反搏(IABP)在老年急性冠状动脉综合征(ACS)患者治疗中的应用及预后以及影响预后的因素。方法回顾性分析2005年1月～2011年1月住院置入IABP的ACS患者76例,根据年龄分为<75岁组40例,≥75岁组36例,分析其住院期间及1年的预后。结果 76例患者中,院内死亡22例,占28.9%,1年死亡29例,占38.2%,2组院内病死率比较差异无统计学意义(P>0.05),≥75岁组较<75岁组1年病死率明显升高(P<0.05)。Kaplan-Meier生存曲线显示,与<75岁组比较,≥75岁组患者1年生存率明显降低(P=0.009)。Cox比例风险回归模型分析显示,年龄偏大、LVEF降低、PCI术后TIMI血流0～1级降低是1年死亡的独立危险因素。结论联合IABP治疗的ACS患者预后良好。高龄、LVEF低、PCI术后TIMI血流降低,是应用IABP的ACS患者1年死亡的独立危险因素。     

利尿剂对氯吡格雷抗栓治疗的PCI术后急性冠脉综合征患者预后的影响

目的:探讨利尿剂对急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后氯吡格雷抗血小板治疗预后的影响。方法:根据入选和排除标准,前瞻性连续募集2009年9月~2011年9月,在解放军总医院老年心血管病研究所住院行氯吡格雷抗血小板治疗的PCI术后ACS患者,并对其心血管主要缺血终点事件(心源性死亡,非致死性心肌梗死或者脑卒中,紧急冠状动脉血运重建)和联合缺血终点事件(主要缺血终点事件及明确或可疑支架内血栓形成,复发性心肌缺血或者不稳定型心绞痛再入院治疗,非紧急血运重建)的发生情况进行为期1年的随访。分别利用Logistic多元回归、Kaplan-Meier曲线及Cox多元回归等统计方法,分析利尿剂对PCI术后经氯吡格雷抗血小板治疗的ACS患者心血管缺血终点事件的影响。结果:在750例符合入选标准的PCI术后经氯吡格雷抗血小板治疗的ACS患者中,664例患者完成了为期1年的心血管缺血终点事件的随访。对发生缺血终点事件(n=164)和未发生缺血终点事件(n=500)患者的一般情况和临床特征的单因素比较分析发现,年龄、他汀类药物、血管紧张素转化酶抑制剂/血管紧张素受体阻断剂和利尿剂的应用在两组患者之间具有显著性的差异(P0.05,P0.01)。Logistic多元回归分析发现,联合应用利尿剂是心血管主要缺血终点事件(OR:2.99,95%CI:1.37-6.54,P0.01)及联合缺血终点事件(OR:2.37,95%CI:1.53-3.68,P0.01)发生的独立危险因素。Kaplan-Meier曲线和Cox多元回归分析均发现,联合应用利尿剂的患者1年内发生联合缺血终点事件的风险显著高于未使用利尿剂的患者(P0.01)。结论:联合应用利尿剂增加了经氯吡格雷抗血小板治疗的PCI术后ACS患者心血管缺血终点事件发生的风险。     

Abciximab-facilitated percutaneous coronary intervention and long-term survival--a prospective single-center registry.

AIMS: To identify predictors of use of abciximab and evaluate the long-term survival after percutaneous coronary intervention with or without abciximab in a broad spectrum of patients. METHODS: We prospectively evaluated, in a dedicated registry, the 4-year survival of patients undergoing percutaneous revascularization and the treatment with or without abciximab, using the Social Security Death Index. RESULTS: Among 10,471 patients treated between 2/1/1995 and 12/31/2001, 5655 received abciximab and 4816 did not. Propensity score analysis (c-statistic 0.83) identified the following variables to be independently associated with abciximab use: later date of procedure, stent use, acute or recent infarction, increasing lesion complexity, vein graft intervention, hyperlipidemia, normal renal function, male gender and decreasing age. Procedural success was higher in the abciximab group, 93 vs. 89%, P<0.001. Unadjusted Kaplan-Meyer survival analysis demonstrated a strong trend for improved survival in the abciximab group at 4 years, 86.3 vs. 84.7%, P=0.09. In the 7533 patients with acute coronary syndromes (ACS), the respective values were 86.0 vs. 83.6%, P=0.03. Multivariate Cox proportional hazard analysis identified increasing age, significant left ventricular dysfunction or congestive heart failure, chronic renal insufficiency and diabetes mellitus as main predictors of mortality. Abciximab was independently associated with improved survival only in patients with ACS (adjusted HR 0.87, 95% confidence interval, 0.81-1.00, P=0.05). Abciximab use was associated with a higher rate of access site hematoma (2.8 vs. 1.5%) and blood product transfusion (6.8% vs. 4.8%), P<0.001 for both. CONCLUSION: Abciximab use improves procedural success and is associated with lower 4-year mortality in patients with ACS, for whom it should be strongly considered. A lesser effect is seen in patients without high-risk characteristics.     

Serum gamma-glutamyl transferase activity: new high-risk criteria in acute coronary syndrome patients?

In acute coronary syndromes (ACS), oxidation and inflammation have very important roles and in-vitro studies have demonstrated that gamma-glutamyl transferase (GGT) participates in such oxidative and inflammatory reactions. We aimed to evaluate the prognostic value of baseline serum GGT activity on the development of major adverse cardiac event (MACE) in the follow-up of the patients with ACS in coronary care unit (CCU), after 1 and 6 month periods. We included 117 patients (mean age: 61.2+/-11.3 years, 93 males) hospitalized in CCU with the diagnosis of ACS. All had baseline serum GGT activity and were free of systemic and hepatobiliary disease. MACE was defined as the composite of mortality from cardiac causes, recurrent hospitalization with ACS and nonfatal recurrent myocardial infarction diagnoses, to need for coronary revascularization during CCU, over 1 and 6 month follow-up periods. During the follow-up of CCU, MACE occurred in 17 (14.5%) patients (two died). Serum GGT activity was significantly higher in the patients with MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-CCU [relative hazard: 1.05, 95% confidence interval (CI): 1.01-1.09, P=0.007]. During the follow-up of 1 month, MACE occurred in 23 (20.0%) patients (five died). Serum GGT activity was significantly higher in patients with MACE than those free of MACE (P=0.021) and GGT was found as the independent predictor of the development of MACE-1 month (relative hazard: 1.04, 95% CI: 1.01-1.08, P=0.039). During the follow-up of 6 months, MACE occurred in 24 (21.8%) patients (two died). Again, GGT was significantly higher in patients who developed MACE than those free of MACE (P=0.001) and GGT was found as the independent predictor of the development of MACE-6 months (relative hazard 1.06, 95% CI: 1.03-1.10, P<0.001). Serum GGT activity was found to be an independent predictor of the development of MACE in the patients with ACS during CCU, over 1 and 6 month follow-up periods.     

急性冠脉综合征患者PCI术后血浆CLEC-2水平与预后的关系

目的:探讨急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后血浆C型凝集素样受体2(CLEC-2)水平与预后的关系。方法:前瞻性选取2016年1月至2017年6月在首都医科大学附属北京潞河医院就诊的150例ACS患者作为研究对象。采用受试者工作特征(ROC)曲线分析CLEC-2评估ACS患者预后的最佳截断点。根据CLEC-2评价ACS患者预后的最佳截断点将患者分为高CLEC-2组(n=32)和低CLEC-2组(n=118)。采用酶联免疫吸附法检测ACS患者血浆中CLEC-2水平,并通过Cox回归分析其与ACS患者预后的关系。结果:血浆CLEC-2评价ACS患者预后的ROC曲线下面积(AUC)为0.885(95%CI:0.812~0.958),最大约登指数为0.643,最佳截断点为158.63 pg/mL,敏感度为71.87%,特异度为92.37%。两组在年龄、ACS家族史、CLEC-2水平及左室射血分数(LVEF)等方面的差异有统计学意义(P均<0.05)。高CLEC-2组主要不良血管事件(MACE)的发生率明显高于低CLEC-2组(71.88%对7.63%,P<0.001),平均生存时间明显低于低CLEC-2组[17.25(15.40~19.10)个月对23.34(22.91~23.77)个月,P<0.001]。Cox单因素及多因素分析结果显示慢性阻塞性肺疾病及CLEC-2水平与ACS患者MACE发生密切相关。结论:高CLEC-2是ACS患者PCI后发生MACE的独立危险因素。     

Comparison of one-year outcome of patients aged <75 years versus ≥75 years undergoing "rescue" percutaneous coronary intervention

The influence of age on the clinical results after rescue angioplasty (percutaneous coronary intervention [PCI]) has been poorly investigated. In the present study, we evaluated the outcome of 514 consecutive patients undergoing rescue PCI who were divided into 2 groups according to age: <75 years (n = 469) and ≥75 years (n = 45). The primary end point of the study was the incidence of death at 1 year of follow-up. The secondary end point was the 1-year incidence of major cardiac adverse events (MACE) defined as a composite of death, recurrent acute myocardial infarction, and target vessel revascularization. The predictors of death and MACE at 1 year were also investigated. At 1 year of follow-up, the <75-year-old group had a significantly lower incidence of death (7% vs 24%, p = 0.0001) and MACE (14% vs 28%, p = 0.01) compared to the ≥75-year-old group. The Cox proportional hazards model identified age (adjusted hazard ratio 0.2665, 95% confidence interval 0.1285 to 0.5524, p = 0.0004), cardiogenic shock (hazard ratio 0.1057, 95% confidence interval 0.0528 to 0.2117, p <0.000001), Thrombolysis In Myocardial Infarction flow grade 2 to 3 after PCI versus 0 to 1 (hazard ratio 3.8380, 95% confidence interval 1.7781 to 8.2843, p = 0.0006), multi- versus single-vessel disease (hazard ratio 0.3716, 95% confidence interval 0.1896 to 0.7284, p = 0.0039) as independent predictors of survival at 1 year of follow-up. In conclusion, at 1 year of follow-up after rescue PCI, the patients aged ≥75 years had a greater incidence of death and MACE compared to patients aged <75 years. Age, cardiogenic shock, Thrombolysis In Myocardial Infarction flow grade 0-1 after PCI, and multivessel coronary disease were predictors of survival and freedom from MACE at 1 year of follow-up.