Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery bypass grafting with radial arteries on long-term patency and mortality.     

心理干预对PTCA围手术期患者的影响

目的:探讨心理干预对冠心痛介入术(PTCA)治疗患者身心康复的影响.方法:冠心病患者40例,随机分为实验组和对照组各20例,均行经皮冠状动脉腔内成形术(PTCA)治疗,术前后实验组患者配合系统的心理干预,对照组按常规护理.结果:抑郁和焦虑自评量表(SDS、SAS)评分入院时2组比较差异无显著性意义.PTCA后实验组SAS及SDS评分较治疗前及对照组比较均明显下降(P0.01).结论:心理干预对PTCA后患者的身心康复有明显促进作用.     

冠心病介入治疗的临床分析

目的 :观察冠心病介入治疗的有效性和安全性。方法 :2 0 0 1.6～ 2 0 0 2 .5月 ,我院共对112例冠心病患者实施了经皮冠脉成形术 (PTCA)和冠脉内支架置入术 (CASI) ,其中 ,包括 4 3例紧急冠状动脉内支架术。结果 :本组行PTCA成功 15 0处 ,失败 4处 ,成功率 97.0 %。其中A、B型病变成功率均为 10 0 % ,C型病变成功率为 87.5 %。失败者为 4例冠脉完全闭塞 ,1例不稳定型心绞痛 ,1例急性心肌梗塞 ,2例陈旧心梗。其中 2处病变导丝不能通过 ,1处病变导丝通过后球囊不能通过 ,病变扩张前目测平均狭窄是 87.9%。PTCA后置入支架及直接支架置入共 112例 (15 4处病变 ) ,其中病变A型 6 8处 ,B型 6 0处 ,C型 2 8处 ,置入支架 15 4支 ,平均 1.1支 /处 ,即刻成功率 10 0 %。因病变较长或两支以上病变 ,有 2 4例患者置入 2只支架 ,7例置入 3只支架。急诊PTCA4 3例 ,直接PTCA4 2例 ,挽救PTCA1例 ,成功率 97.6 %。结论 :PTCA及支架植入术治疗冠心病是安全有效的。     

Application of GlycoProtein IIb/IIIa antagonist( Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese

Objective: to report the application of GPIIb/IIIa antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in Chinese. Method: Twenty-one patients who underwent percutaneous transluminal catheter angioplasty(PTCA) and stent implantation were included. After arterial puncture, integrilin was injected at dose of 180ug/kg, and then maintained at 2μg/kgmin for 18 hours. Asprine, plavix(clopidogrel) and heparin were used at the same time. ACT, PT, KPTT and blood routine were routinely monitored. Results: All sheaths were drawn out 2 to 4 hours after the procedure.. There was no severe complication such as hematoma, acute and subacute thrombosis in coronary artery, or thrombocytopenia. ACT returned to less than 150 seconds in 2 hours in 15 patients; in 4 hours in 6 patients. There was no significant difference between the pre- and post-procedure value of PT and platelet count. KPTT was significantly higher than pre-procedure value at 2 hours after the procedure .No recurrence of angina pectoris was observed in the first nine patients within one year follow-up, and no restenosis occurred in stents in the five patients who had coronary angiography one year later. Conclusion: Application of GPIIb/IIIa receptor antagonist (Integrilin) in peri-percutaneous transluminal catheter angioplasty and stent implantation in combination with aspirin and plavix could significantly reduce the dosage and duration of heparin with benefit of shortening the indwelling time of sheaths, but did not increase risk of bleeding or lead to thrombosis in stent.     

黄淮白山羊心脏冠状动脉形态特征研究

目的:观察黄淮白山羊心脏冠状动脉的形态学特征,为其研究提供基础资料.方法:选择成年健康黄淮白山羊10头,采用颈静脉放血方式处死,其中6只心脏取不同管径大小的冠状动脉,多聚甲醛溶液固定,经水洗、脱水、二甲苯透明,石蜡包埋以HE、Masson三色及Verhoeff VG染色等步骤,观察冠状动脉的基本组织结构特点;另4只心脏标本经左、右冠状动脉口分别加压注入丁腈苯乙烯(ABS)丙酮溶液,经凝固成型后于70%浓盐酸溶液中腐蚀,观察冠状动脉的分支与分布.结果:黄淮白山羊的心脏左、右冠状动脉均起自于主动脉窦,行走于肺动脉与左心耳之间的左冠状动脉较粗大.黄淮白山羊弹性冠状动脉中弹性纤维含量丰富,外膜层有散在分布的块状平滑肌;肌性冠状动脉内外弹性膜结构清晰,中膜层主要由发达的平滑肌构成,含少量弹性纤维;微冠状动脉由一层内皮细胞构成.结论:黄淮白山羊冠状动脉属于左优势型,可分为弹性冠状动脉、肌性冠状动脉和微动脉三种类型.     

冠状动脉三支病变心电图特征

目的：通过冠状动脉造影术与常规心电图比较，分析冠状动脉三支病变的心电图特征。方法：选择68例冠状动脉造影冠状动脉三支病变的患者，进行常规12导联心电图特点分析，预测心电图对冠状动脉三支病变的临床意义。结果：心电图对冠状动脉三支病变的诊断缺乏特异性。结论：冠状动脉造影术是诊断冠状动脉三支病变的金标准。     

Congenital atresia of the left main coronary artery in an infant

Congenital atresia of the left main coronary artery is a rare occurrence, and surgical revascularizationbypass graft is required. We here report a rare case of congenital coronary anomaly in an infant. A 10-month-old male infant was admitted to the hospital with heart failure symptoms. Echocardiographic examinations revealed mitral valve regurgitation and ischemic changes of the anterolateral papillary muscle and chordae. Coronary angiography showed atresia of the left main coronary artery with a severe hypoplastic left anterior descending artery and a circumflex coronary artery. Unfortunately, sudden cardiac arrest occurred after catheterization and the infant did not recover despite of immediate cardiopulmonary resuscitation. Further studies are needed to find a newer diagnostic method to detect coronary anomaly in an infant, and coronary angiography, if necessary, has to be performed very carefully.     

Current status and development of percutaneous coronary intervention in China

##正##Dr.Gruntzig et al.(1979) successfully completed the world's first percutaneous coronary intervention (PCI),a percutaneous transluminal coronary     

Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

Case Report: Coronary arterial spasm in single right coronary artery

We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.     

冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床研究

目的：研究冠心病患者颈动脉粥样硬化与血管内皮舒张功能的临床意义。方法：采用高频超声测量冠心病组和对照组颈动脉斑块积分、斑块数、颈动脉内-中膜厚度（IMT）及血管内皮舒张功能（EDD％），并进行对比分析。结果：1．冠心病组颈动脉IMT、斑块积分及斑块数明显高于对照组，多支冠脉血管病变组明显高于单支病变组；2．冠心病组内皮舒张功能明显低于对照组，单支、双支病变组间无显著性差异。3．冠状动脉造影与颈动脉超声结果比较，以斑块存在为预测冠脉病变的阳性指标，敏感性为83％、特异性75％。结论：冠心病患者多合并血管舒张功能受损及颈动脉粥样硬化，高频超声探查颈动脉可预测冠状动脉病变的存在及严重程度。     

小儿川崎病86例临床分析

目的:探讨川崎病(KD)早期诊断要点与减少心血管损伤的治疗方法.方法:对86例确诊KD的住院患儿的临床特点、实验室检查、心电图及超声心动图进行检查,对定期随访结果进行分析.结果:临床特点中肛周红与卡瘢红发生率分别为53.4%、40.7%;超声心动图检查发现冠状动脉扩张28例,冠状动脉瘤5例;用静脉丙种球蛋白(IVIG)治疗的冠状动脉病变发生率33.3%,仅用阿司匹林治疗的冠状动脉病变发生率64.2%,7d内使用IVIG治疗的冠状动脉病变发生率9.6%(P＜0.01).结论:对非典型KD应及时做超声心动图检查,早期足量使用IVIG可减少KD并发冠状动脉病变的发生.     

经桡动脉行冠状动脉介入治疗的循证护理

冠心病是严重危害人类健康的主要疾病,经皮冠状动脉介入法已经在国内广泛应用于临床治疗冠状动脉粥样硬化,成为目前治疗冠心病的主要方法之一。经桡动脉介入治疗应运而生,因其损伤小、局部并发症少,手术前后对抗凝、抗血小板药物限制小,术后立即拔管,患者即可随意下地活动而越来越受到患者和介入医生的欢迎。虽然大多数文献报道经桡动脉介入治疗的并发症明显低于经股动脉介入治疗。但由于桡动脉途径自身的生理特点及局限性,并发症也并不少见,如处理不当,有时会导致严重的后果,因此,在经桡动脉行冠状动脉介入手术时应注意观察及护理。     

清营活血汤辅助治疗小儿川崎病32例临床观察

目的:探讨减少川崎病发生冠状动脉病变的治疗方法.方法:用清营活血汤(自拟)结合西药治疗川崎病32例.观察临床表现的消失时间和冠状动脉病变的发生率.结果:清营活血汤结合西药治疗川崎病,冠状动脉病变发生率为15.6%,纯西药组50%,有显著差异(P＜0.05),而临床表现的消退时间无明显差异性.结论:清营活血汤对减少川崎病发生冠状动脉病变有显著的治疗和预防作用.     

基质金属蛋白酶与冠心病

冠心病的病理学基础是动脉粥样硬化.目前认为动脉粥样硬化的形成和斑块的破裂与细胞外基质的破坏和重构有密切关系,而基质金属蛋白酶(MMPs)是降解细胞外基质的重要酶类.对近年来关于MMPs的结构、功能、基因表达以及在冠心病中的作用的研究取得的成果进行了综述.     

Off-pump coronary artery bypass grafting versus on-pump coronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

To evaluate the clinic outcome of off-pump coronary bypass grafting (OPCABG) of patients with coronary heart disease and chronic obstructive pulmonary disease, we collected and analyzed 1998-2002 data on 28 patients with these two diseases who had received off-pump coronary bypass operation in our hospital, and compared with data on those who also had the same two diseases but received on-pump coronary artery bypass at same time. There were no operation-related death;one died of respiratory failure 14 days after operation while staying in hospital; there were more respiratory complications in the conventional coronary artery bypass grafting group (CCABG) than in the OPCABG group; and the PaO2/FiO2 in the CCABG group was higher than that in the OPCABG group during operation because of CPB, but lower than that in the OPCABG group 6-12 hours after operation. OPCABG seemed more suitable than CCABG for coronary artery disease patients with chronic obstructive pulmonary disease due to less damage to their oxygen-exchange capability and the fewer respiratory complications.     

Off-pump coronary artery bypass grafting versus on-pumpcoronary artery bypass grafting: which is better in patients with chronic obstructive pulmonary disease?

INTRODUCTION Conventional coronary artery bypass graftin(CCABG) with cardiopulmonary bypass (CPB) habeen accepted as an effective and safe treatment fomulti-vessel coronary heat disease. CPB may stilcontribute to the operation field because of threlatively easier technical requirement; but it alscauses a serious systematic inflammatory reactiowhich will lead to dysfunction of important organand higher cost for the patients. Off-pump coronarartery bypass grafting (OPCABG) has r…     

川崎病冠状动脉病变48例临床分析

目的 :了解川崎病冠脉病变的发展过程 ,探讨动态超声心动图检查的价值。方法 :本文回顾分析了 4 8例川崎病患者的超声检查结果。结果 :本组病例冠状动脉病变发生率为6 0 % ,冠状动脉扩张 35例 ,占 73% ,冠状动脉瘤 13例 ,占 2 7% ,最早 1例是发病后 4d。结论 :川崎病急性期一过性冠脉扩张较普遍 ,超声心动图随访检查可提高冠脉病变的检出率 ,了解冠脉病变的动态变化 ,利于早期诊断和指导治疗。     

Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease

The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.     

Clinical and angiographic features associated with coronary collateralization in stable angina patients with chronic total occlusion

Objective

Coronary collateral circulation is an alternative source of blood supply to myocardium in the presence of advanced coronary artery disease. We sought to determine which clinical and angiographic variables are associated with collateral development in patients with stable angina and chronic total coronary occlusion.

Methods

Demographic variables, biochemical measurements, and angiographic findings were collected from 478 patients with stable angina and chronic total coronary occlusion. The presence and extent of collaterals supplying the distal aspect of a total coronary occlusion from the contra-lateral vessel were graded from 0 to 3 according to the Rentrop scoring system.

Results

Low (Rentrop score of 0 or 1) and high (Rentrop score of 2 or 3) coronary collateralizations were detected in 186 and 292 patients, respectively. Despite similar age, cigarette smoking, and medical treatment, patients with low collateralization were female in a higher proportion and less hypertensive, and had higher rates of type 2 diabetes and dyslipidemia than those with high collateralization (for all comparisons, P<0.05). In addition, patients with low collateralization exhibited more single-vessel disease, less right coronary artery occlusion, more impaired renal function, and higher serum levels of high-sensitivity C-reactive protein (hsCRP) compared with those with high collateralization. Multivariate analysis revealed that age of ≥65 years, female gender, diabetes, no history of hypertension, dyslipidemia, moderate to severe renal dysfunction, single-vessel disease, and elevated hsCRP levels were independently associated with low coronary collateralization.

Conclusions

Coronary collateralization was reduced in almost 40% of stable angina patients with chronic total occlusion, which was related to clinical and angiographic factors. The impact of coronary collateralization on outcomes after revascularization needs further investigation.