【摘要】目的 探討胸部X線片檢查發現的主動脈弓鈣化與冠心病的不同臨床表現類型的相關性。方法 回顧分析2006年7月-2008年2月期間經冠狀動脈造影證實的冠心病患者的臨床資料,對比分析胸部平片所見的主動脈弓鈣化情況與冠心病不同臨床類型的相互關系。結果 116例經冠狀動脈造影證實的冠心病患者納入研究。其中,穩定型心絞痛40例,急性冠脈綜合征76例(不穩定型心絞痛21例、非ST段抬高心肌梗死38例、ST段抬高心肌梗死17例)。40例穩定型心絞痛患者中,有主動脈弓鈣化者21例,占52.5%;76例急性冠脈綜合征患者中,有主動脈弓鈣化者22例,占28.9%。與急性冠脈綜合征相比,更多的穩定型心絞痛患者合并有主動脈弓鈣化(χ2=6232,P=0013)。結論 在不同的冠心病臨床類型,主動脈弓鈣化更易在穩定型心絞痛患者中發現。【Abstract】 Objective To investigate the relationships between calcification of aortic arch and different clinical classification of coronary artery disease. Methods The clinical data of patients with coronary artery diease who diagnosed by arteriography from July 2006 to February 2008, were retrospectively analyzed. The Xray data on calcification of aortic arch and clinical characteristics of patients with coronary artery disease confirmed by coronary angiography were analyzed. The relationship between coronary calcification of aortic arch which showed by Xray and different clinical classification of coronary artery disease were comparatively analyzed. Results Among the total of 116 patients, 40 stable angina and 76 acute coronary syndrome were included, and 21 (52.5%) and 22 (28.9%) patients with calcification of aortic arch were observed respectively. In comparison to patients with acute coronary syndrome, more stable angina patients were complicated with calcification of aortic arch (χ2 =6232,P=0013). Conclusion It is more likely to document calcification of aortic arch in patients with stable angina.
ObjectiveTo explore the prevalence of depression and anxiety of chronic obstructive pulmonary disease complicated coronary artery disease before and after percutaneous intracoronary arterial stenting.
MethodsA total of 114 chronic obstructive pulmonary disease complicated coronary artery disease patients were enrolled in this study and were measured with the Hospital Anxiety and Depression Scale before and after percutaneous intracoronary arterial stenting.
ResultsA total of 71 patients (62.3%) had depression symptom and 68 patients (59.6%) had anxiety symptom before percutaneous intracoronary arterial stenting. There were 46 patients (40.4%) had significant depression symptom and 40 patients (35.1%) had significant anxiety symptom before percutaneous intracoronary arterial stenting. A total of 85 patients (74.6%) had depression symptom and 83 patients (72.8%) had anxiety symptom after percutaneous intracoronary arterial stenting. There were 60 patients (52.6%) had significant depression symptom and 48 patients (42.1%) had significant anxiety symptom after percutaneous intracoronary arterial stenting. There was significant difference in prevalence rate of depression and anxiety before and after percutaneous intracoronary arterial stenting (P < 0.05).
ConclusionsThe patients with chronic obstructive pulmonary disease complicated coronary artery disease show higher prevalence of depression and anxiety. The prevalence of depression and anxiety increases significantly after percutaneous intracoronary arterial stenting.
Abstract： Objectives To evaluate the early and mid-term follow-up outcomes of “one-stop” hybrid coronary revascularization strategy for patients with multivessel coronary artery disease. Methods From June 2007 to December 2009, 104 consecutive patients underwent “one-stop”hybrid coronary revascularization in Fu Wai Hospital. There were 93 male patients and 11 female patients with mean age of （61.8±10.2）years（ranging from 35 to 81 years）. All the patients had multivessel coronary artery disease including left anterior descending （LAD）coronary artery stenosis, and underwent “one-stop”hybrid coronary revascularization. “One-stop”hybrid procedure was first performed through a lower partial sternotomy at the second left intercostal space. The distal anastomosis of in situ left internal mammary artery （LIMA）to LAD graft was completed. Angiography was performed immediately to confirm patency of the LIMA graft after closure of the thorax. A 300 mg loading dose of clopidogrel was administered through a nasogastric tube after confirmation of LIMA graft patency. Intravenous unfractionated heparin was administered to obtain an activated clotting time of greater than 250 s. Then percutaneous coronary intervention（PCI）was performed on the non-LAD lesions. Results All the patients underwent“one-stop”hybrid coronary revascularization including grafted LIMA to LAD，and one hundred and ninety one drug eluting stents and three bare metal stents were used for other non-LAD lesions. No death event occurred during surgery and in hospital. All the patients were followed up for a mean duration of 1.5 years. There was no myocardial infarction, neurologic event or death occurred during follow-up except one patient with stent stenosis who was treated by PCI. Conclusion “One-stop” hybrid coronary revascularization is a feasible and safe alternative for patients with multivessel coronary artery disease.
Abstract： Objective?To summarize our experience of redo coronary artery bypass grafting（CABG） and explore appropriate redo CABG strategy for Chinese patients. Methods We retrospectively analyzed clinical data of 27 patients who underwent redo CABG in People’s Hospital of Peking University from January 2000 to January 2010. There were 15 male patients and 12 female patients with their age of 41-84 （63±8） years. The mean time between the first CABG and the redo CABG was 45 （4-168） months. Preoperatively all the patients had unstable angina pectoris. Twenty-one patients were in New York Heart Association （NYHA） functional classⅠ-Ⅱ， and 6 patients were in NYHA functional classⅢ-Ⅳ. Preoperatively， their left ventricular end-diastolic dimension （LVEDD） was 41-69 （51.0±0.7） mm， and their left ventricular ejection fraction （LVEF） was 32%-78% （58%±12%）. At the time of redo CABG for the 27 patients， there were 6 new coronary artery lesions， 7 left internal mammary artery （LIMA） lesions， 3 radial artery lesions （including 1 proximal anastomosis lesion alone） and 49 saphenous vein graft （SVG） lesions （including 3 proximal lesions alone and 3 distal lesions alone）.?Results?The surgical approach of redo CABG included median sternotomy in 18 patients， left lateral thoracotomy in 8 patients， upper midline abdomen and subxiphoid incision in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） surgery was performed in 25 patients， but intra-operatively 2 patients underwent conversion to CABG under cardiopulmonary bypass. A total of 65 distal anastomoses and 41 proximal anastomoses were performed during redo CABG. A total of 10 LIMA， 3 right internal mammary artery (RIMA)， 16 left radial artery， 2 right radial artery and 17 SVG were used in redo CABG . There were 1-4 （2.4±0.8） distal anastomoses for each patients. The operation time was 170-530 （304±86）min. Postoperative transfusion was 0-10 （4.3±3.5） U packed red blood cells and 0-1 600 (685±549) ml fresh frozen plasma for each patient. Postoperative mechanical ventilation time was 6-156 （24±32） h and postoperative hospital stay was 7-35 （14±6） d . There was no in-hospital death. All the patients were discharged without any angina symptoms. A total of 26 patients were followed up and 1 patient was lost with the mean follow-up time of 80 （13-133） months. During follow-up， 16 patients were alive without angina symptoms， 4 patients died， and 6 patients had recurrent angina symptoms or heart failure. Conclusions OPCAB is an effective surgical strategy of redo CABG， but cardiopulmonary bypass should also be prepared. Arterial graft should be use as long as possible in redo CABG and the surgical strategy should be individualized.
ObjectiveTo systematically review the models for predicting coronary artery disease (CAD) and demonstrate their predictive efficacy. MethodsPubMed, EMbase and China National Knowledge Internet were searched comprehensively by computer. We included studies which were designed to develop and validate predictive models of CAD. The studies published from inception to September 30, 2020 were searched. Two reviewers independently evaluated the studies according to the inclusion and exclusion criteria and extracted the baseline characteristics and metrics of model performance.ResultsA total of 30 studies were identified, and 19 diagnostic predictive models were for CAD. Seventeen models had external validation group with area under curve (AUC)>0.7. The AUC for the external validation of the traditional models, including Diamond-Forrester model, updated Diamond-Forrester model, Duke Clinical Score, CAD consortium clinical score, ranged from 0.49 to 0.87.ConclusionMost models have modest discriminative ability. The predictive efficacy of traditional models varies greatly among different populations.
Objective To evaluate the efficacy and safety of drug-eluting stents in treating patients with coronary artery disease compared with bare metal stents. Methods MEDLINE, EMBASE, CBMdisc and other databases of clinical trials were searched for meta-analysis and randomized controlled trials (RCTs) both in Chinese and English language. Conference abstracts, personal reference lists, reference lists of retrieved studies and some websites were also searched. Statistical analysis was performed using RevMan 4.2 software. Results Meta-analysis was performed on the results of 25 RCTs with 5 different drug-eluting stents. Seven trials evaluated efficacy and safety of sirolimus-eluting stent, the results of meta-analysis indicated that SES decreased rates in stent restenosis compared with bare metal stent, and therefore the target lesion revascularization and adverse cardiac event rates, no “catch up” were found. Eight trials compared a paclitaxel-eluting stent with bare metal stent, similar results were found, i.e. decreased stent restenosis rate, target lesion revascularization and adverse cardiac event rates in patients receiving paclitaxel-eluting stent compared with bare metal stent. Three trials compared CYPHERTM and TAXUS stents head to head, and the combined analysis showed a superiority of CYPHERTM to TAXUS. But available data can not draw a conclusion with regard to the effect of drug-eluting stents on mortality, occurrence of MI or stent thrombosis. Everolimus-eluting stent had the same performance as these two drug-eluting stents above, but because of a small sample size, no further conclusion can be made. Actinomycin D eluting stents and 7-hexanoyltaxol-eluting stents increased restenosis rate and stent thrombosis rate respectively. Poor performance limited further clinical trials of these two stents. Conclusions Sirolimus-eluting stent and polymetric paclitaxel-eluting stent are efficient and safe in patients with coronary artery atherosclerosis. Sirolimus eluting stent CYPHERTM seems better than paclitaxel eluting stent TAXUS.
Objective
To study the technical characteristics, clinical outcomes and short- and long-term results of minimally invasive multi-vessel coronary artery bypass grafting and to evaluate the feasibility and efficacy.
Methods
From April 2012 to December 2014, minimally invasive cardiac surgery for coronary artery bypass grafting (MICS CABG) in 11 patients was performed in the First Hospital of China Medical University. All patients were males and the average age was 62.7 (47.0-73.0) years. Eight patients with 3-vessel lesions and 3 patients with 2-vessel lesions. General anesthesia was performed with double lumen endotracheal intubation and single lung ventilation. The patient was positioned 15 degrees to 30 degrees in right lateral position. The left anterior and lateral incision was made at the fourth/fifth intercostal space with the length of 5-7 cm and 2/3 part of the incision located in the medial side of anterior axillary line. Left internal thoracic artery (LIMA) was harvested from the third intercostal space up to the subclavian vein and down to more than fifth intercostal space through the surgical window. Through the xiphoid and sixth intercostal space incision with the length of 1 cm, the Starfish and Octopus system were placed to fix apex and ascending aorta and target vessels were exposed. The proximal and distal anastomosis was done under the direct vision. The sequence of distal anastomosis was from posterior descending branch to obtuse/diagonal branch and left anterior descending branch. The chest and pericardial draining tubes were placed through the xiphoid and sixth intercostal space incision.
Results
The mean operation time was 4.1 (3.2–5.8) h. Five patients underwent the operation with the assist of cardiopulmonary bypass and the mean assisting time was 21.0 (17.0-38.0 ) min. The mean number of distal anastomosis was 2.8 (2.0-3.0) and LIMA was harvested and grafted in all 11 patients. The mean drainage was 425.0 (180.0-750.0) ml, mean ventilation time 7.8 (4.3-11.2) h, ICU stay 15.9 (11.0-38.0) h, and hospital time 7.7 (5.0-14.0) d. There was no operative death and re-exploration for bleeding. One patient was complicated by paroxysmal atrial fibrillation and one patient myocardial infarction. The average follow-up was 19.4 (12.0-36.0) months, and no chest pain, re-admission or re-intervention happened. Coronary artery CT angiographies demonstrated that all LIMAs were patent and 4 vein grafts were occluded and venous graft patency rate was 80.0% one year after surgery.
Conclusion
MICS CABG has the advantage of quick recovery, good cosmetic effect and low incision infection rate compared to the conventional CABG. Compared with robotic surgery, the cost of MICS CABG is low and the same as that of the conventional CABG. It is a new kind of CABG and could be performed following the learning curve under strict training of doctors and careful patient selection. With the good short- and middle-term results, MICS CABG needs to be evaluated for long-term graft patency rate, re-revascularization rate, and clinical evidence.
Objective To systematically review the impact of cardiac shock waves on coronary artery disease. Methods The PubMed, Cochrane Library, Wed of Science, EMbase, ClinicalTrials.gov, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials and cohort studies related to the treatment of coronary artery disease with cardiac shock waves from inception to August 2022. After two evaluators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies, a meta-analysis was conducted by using RevMan 5.4.1 and Stata 15.0 software. Results A total of 11 studies with 519 patients were included. The meta-analysis results revealed that compared with the control group, cardiac shock wave therapy could reduce hospitalization rates (RR=0.38, 95%CI 0.25 to 0.57, P<0.01), increase exercise time (SMD=0.93, 95%CI 0.17 to 1.70, P=0.02), and improve the Canadian Cardiovascular Society (CCS) angina grading (MD=?0.62, 95%CI ?0.73 to ?0.51, P<0.01), the New York Heart Association (NYHA) cardiac function grading (MD=?0.60, 95%CI ?0.85 to ?0.35, P<0.01), left ventricular ejection fraction (MD=4.81,95%CI 3.17 to 6.46, P<0.01), total score of the Seattle angina questionnaire (SAQ) (MD=10.87, 95%CI 4.63 to 17.12, P<0.01), and 6-min walking test (MD=85.06, 95%CI 31.02 to 139.09, P<0.01). Conclusion Cardiac shock wave therapy can improve cardiac function as well as the prognosis and exercise ability. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo investigate the factors related to recurrent coronary events in patients after coronary artery stent implantation.
MethodsWe retrospectively studied the patients performing coronary angiography (CAG) who were admitted to the Department of Cardiology of the Second Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2013. All of the enrolled patients had received CAG in our hospital, with complete coronary angiogram and clinical data. The patients were divided into two groups according to the coronary angiogram and clinical data: coronary event group and non-coronary event group. SPSS 16.0 software was employed for statistical analysis, and multivariate analysis was performed using binary logistic regression model to analyze the risk factors.
ResultsA total of 115 patients were included, of which 50 patients had recurrent coronary events. Both the serum total bilirubin and unconjugated bilirubin in patients with coronary events were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05 or P < 0.01). The serum total bilirubin at baseline and the serum total bilirubin and unconjugated bilirubin at the time of CAG reexamination were significantly lower in patients with revasculization due to the progression of coronary artery lesions compared with the patients without coronary events (P < 0.05 or P < 0.01). The serum unconjugated bilirubin in patients with in-stent restenosis were significantly lower compared with the patients without coronary events at baseline and at the time of CAG reexamination (P < 0.05). The results of logistic regression analysis showed that multi-vessel coronary artery disease (two-vessel coronary artery disease: OR=10.094, 95%CI 2.498 to 40.798, P=0.001; three-vessel coronary artery disease: OR=16.047, 95%CI 4.121 to 62.481, P=0.000) and low serum unconjugated bilirubin (OR=0.873, 95%CI 0.773 to 0.987, P=0.03) were independent risk factors of recurrent coronary events.
ConclusionMulti-vessel coronary artery disease and low serum unconjugated bilirubin are independent risk factors of recurrent coronary events in patients after coronary artery stent implantation.
ObjectiveTo investigate the technique and efficacy of left atrial appendage (LAA) occlusion during off-pump coronary artery bypass grafting (OPCABG) in elderly patients with coronary artery disease (CAD) and atrial fibrillation (AF).MethodsFrom 2013 to 2018, 84 elderly patients with CAD and AF with reduced left ventricular ejection fraction (LVEF< 50%) underwent OPCABG in our department. There were 54 males and 30 females at age of 70-82 years. They were divided into a left atrial appendage (LAA) occlusion group (n=56) and a non-LAA occlusion group (n=28). Postoperative antithrombotic therapy: the LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic therapy” for 3 months after operation, then was changed to aspirin + clopidogrel “dual antiplatelet” for long-term antithrombotic; the non-LAA occlusion group was given warfarin + aspirin + clopidogrel “triple antithrombotic” for long-term antithrombotic after operation. The clinical effectiveness of the two groups was compared.ResultsAll patients underwent the surgery successfully. There were 56 patients in the LAA occlusion group, including 44 patients of LAA exclusion and 12 patients of LAA clip. The time of LAA occlusion was 3 to 8 minutes. There was no injury of graft vessels and anastomotic stoma. Early postoperative death occurred in 2 patients (2.4%). There was no statistical difference between the two groups in postoperative hospital stay (P=0.115). Postoperative LVEF of the two groups significantly improved compared with that before operation (P<0.05). There was no stroke or bleeding in important organs during hospitalization. During follow-up of 1 year, no cerebral infarction occurred in both groups, but the incidence of bleeding related complications in the LAA occlusion group was significantly lower than that in the non-LAA occlusion group (3.6% vs. 18.5%, P=0.036).ConclusionFor elderly patients with CAD and AF with reduced LVEF, LAA occlusion during OPCABG can effectively reduce the risk of stroke and bleeding related complications, and without increasing the risk of surgery.
