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Introduction: Radial artery occlusion (RAO) after transradial access is a common thrombotic complication. A meta-analysis has proven that RAO incidence in transradial coronary angiography (TRCA) settings was significantly higher than that in percutaneous coronary intervention settings. This prospective observational cohort aimed to evaluate radial artery protection after TRCA with different antiplatelet strategies. Methods: A total of 2,316 patients undergoing TRCA was enrolled and divided into two groups: single-antiplatelet and dual-antiplatelet groups. Radial artery patency was evaluated by ultrasound before, at 24 h, and 30 days after TRCA. The primary endpoint was RAO incidence at 30 days after TRCA. Results: A total of 66 RAO was found on ultrasonography at 30-day follow-up (incidence: 2.8%). In the dual-antiplatelet group, the rate of RAO was significantly lower compared with the single-antiplatelet group (1.8 vs. 4.0%; odds ratio (OR): 0.41; 95% confidence interval (CI): 0.24-0.70; p = 0.001). The rate of self-recanalization in the dual-antiplatelet group was significantly higher than that in the single-antiplatelet group (73.68 vs. 44.12%, p < 0.001). However, there was no statistical difference in delayed occlusion of radial artery between the two groups (0.5 vs. 0.2%, p = 0.140). Unexpectedly, this study also showed no significant difference in bleeding risk between the groups. Conclusion: Dual-antiplatelet therapy for 1 month after TRCA was associated with a reduced risk of RAO and deemed safe.
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BACKGROUND: Tanscatheter left atrial appendage (LAA) closure and minimally invasive thoracoscopic LAA occlusion are local interventions of LAA for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). However, the safety and efficacy of these methods have not been compared. This prospective cohort study aimed to assess the safety and efficacy of those two treatment approaches for stroke prevention in NVAF patients. METHODS: Two hundred and nine recurrent NVAF patients who received radiofrequency ablation were enrolled. These patients were treated with transcatheter LAA closure or thoracoscopic LAA occlusion. The patients were followed up from the first postoperative day and evaluated for efficacy endpoints (stroke/transient ischemic attack (TIA), systemic embolism (SE), and death) and a safety endpoint (bleeding events). Perioperative complications were recorded. RESULTS: After a median follow-up of 1.8 years (383 patient-years), the overall rate of the composite efficacy endpoints was similar between the two groups (3.8 vs. 2.7 events per 100 patient-years; HR = 0.71; 95% CI: 0.225-2.237; P = 0.559). However, regarding primary safety endpoint, there were 1.5 bleeding events per 100 patient-years in the thoracoscopic LAA occlusion group, compared with 6.4 in transcatheter LAA closure group (HR = 0.246; 95% CI: 0.074-0.819; P = 0.022). The incidence of operative complications was 3/138 (2.17%) in thoracoscopic LAA occlusion group and 1/71 (1.41%) in transcatheter LAA closure group. CONCLUSIONS: Thoracoscopic LAA occlusion and transcatheter LAA closure have similar efficacy in preventing stroke in NVAF patients. However, the thoracoscopic group had fewer bleeding events than the transcatheter group, but the former group required a longer hospital stay.
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BACKGROUND: Double-armed suture longitudinal intussusception vasoepididymostomy (DA-LIVE) has been widely adopted owing to its simplicity and high success rate; however, specialized double-armed microsutures are required. OBJECTIVE: To provide a novel single-armed suture longitudinal intussusception vasoepididymostomy (SA-LIVE) technique using only two single-armed sutures, named Guo's SA-LIVE. MATERIALS AND METHODS: Four weeks after vasectomy in male adult Wistar rats, vasoepididymostomies were performed using DA-LIVE, SA-LIVE, or Guo's SA-LIVE. After 12 weeks, functional patency was functionally assessed by evaluating for motile spermatozoa distal to the anastomosis. If no motile spermatozoa were visible, the mechanical patency of the anastomosis was tested by the ability of methylene blue to pass through the surgical anastomosis. The key procedure in Guo's SA-LIVE was cutting each needle with over 1cm attaching suture and making a flat overhand bend knot to tie the needle to the other end of the suture, after the needles were passed through the epididymal tubule and then the vasal lumen in an inside-out fashion, and then, the needles were passed through the vasal lumen in an inside-out fashion. RESULTS: The proportions of functional patency were 50.0% (3/6), 33.3% (2/6), and 50% (3/6) for the DA-LIVE, SA-LIVE, and Guo's SA-LIVE groups, respectively (P = .799). The proportions of mechanical plus functional patency for the three methods were 83.3% (5/6), 66.7% (4/6), and 83.3% (5/6), respectively (P = .725). The mean anastomosis times for the three LIVE techniques and the proportions of complications were similar (P = .150 and .758, respectively). CONCLUSIONS: Guo's single-armed suture technique is a potentially effective alternative to perform vasoepididymostomy when specialized double-armed microsutures are not available based on the current animal experiment.
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Azoospermia/cirugía , Microcirugia/métodos , Técnicas de Sutura , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Animales , Masculino , Ratas WistarRESUMEN
BACKGROUND: Many studies have reported the predictive value of the atherogenic index of plasma (AIP) in the progression of atherosclerosis and the prognosis of percutaneous coronary intervention (PCI). However, the utility of the AIP for prediction is unknown after PCI among type 2 diabetes mellitus (T2DM). METHODS: 2356 patients with T2DM who underwent PCI were enrolled and followed up for 4 years. The primary outcome was major cardiovascular and cerebrovascular adverse events (MACCEs), considered to be a combination of cardiogenic death, myocardial infarction, repeated revascularization, and stroke. Secondary endpoints included all-cause mortality, target vessel revascularization (TVR), and non-target vessel revascularization (non-TVR). Multivariate Cox proportional hazards regression modelling found that the AIP was correlated with prognosis and verified by multiple models. According to the optimal cut-off point of the ROC curve, the population was divided into high/low-AIP groups. A total of 821 pairs were successfully matched using propensity score matching. Then, survival analysis was performed on both groups. RESULTS: The overall incidence of MACCEs was 20.50% during a median of 47.50 months of follow-up. The multivariate Cox proportional hazards regression analysis before matching suggested that the AIP was an independent risk factor for the prognosis of T2DM after PCI (hazard ratio [HR] 1.528, 95% CI 1.100-2.123, P = 0.011). According to the survival analysis of the matched population, the prognosis of the high AIP group was significantly worse than that of the low AIP group (HR (95% CI) 1.614 (1.303-2.001), P < 0.001), and the difference was mainly caused by repeat revascularization. The low-density lipoprotein-cholesterol (LDL-C) level did not affect the prognosis of patients with T2DM (P = 0.169), and the effect of the AIP on prognosis was also not affected by LDL-C level (P < 0.001). CONCLUSIONS: The AIP, a comprehensive index of lipid management in patients with T2DM, affects prognosis after PCI. The prognosis of diabetic patients with high levels of the AIP included more MACCEs and was not affected by LDL-C levels. It is recommended to monitor the AIP for lipid management in diabetic patients after PCI and ensure that the AIP is not higher than 0.318. Trial registration This is an observational cohort study that does not involve interventions. So we didn't register. We guarantee that the research is authentic and reliable, and hope that your journal can give us a chance.
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Glucemia/metabolismo , Enfermedad de la Arteria Coronaria/terapia , Diabetes Mellitus Tipo 2/sangre , Dislipidemias/sangre , Lípidos/sangre , Intervención Coronaria Percutánea , Anciano , Beijing/epidemiología , Biomarcadores/sangre , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/mortalidad , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidad , Dislipidemias/diagnóstico , Dislipidemias/mortalidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infarto del Miocardio/mortalidad , Intervención Coronaria Percutánea/efectos adversos , Intervención Coronaria Percutánea/mortalidad , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Increasing evidence has suggested that the presence of remnant lipoproteins is a significant risk factor for atherosclerosis. Remnant lipoproteins are lipoproteins that are rich in triglycerides (TGs), and the main components include very-low-density lipoprotein (VLDL) in the fasting state. Diabetic patients often have hypertriglyceridemia with elevated levels of VLDL cholesterol but normal levels of low-density lipoprotein cholesterol (LDL-C). The aim of the present study was to elucidate the potential role of remnant lipoproteins-induced atherosclerosis in the occurrence and development of in-stent restenosis (ISR) in diabetic patients with coronary artery disease. METHODS: The present study enrolled 2312 patients with type 2 diabetes mellitus who underwent percutaneous coronary intervention from January 2013 to December 2014 and who were followed up by angiography. Patients were divided into two groups based on the presence or absence of ISR, and multivariate Cox's proportional hazards regression modelling showed that remnant-like particle cholesterol (RLP-C) was an independent risk factor for ISR. According to the receiver operating characteristic curve, the optimal cutoff point of the RLP-C was identified, and the patients were further divided into 2 groups. Propensity score matching analysis was performed, and 762 pairs were successfully matched. Log-rank tests were used to compare Kaplan-Meier curves for overall follow-up to assess ISR. RESULTS: The multivariate Cox's proportional hazards regression analysis showed that RLP-C was independently associated with ISR, and the baseline RLP-C level at 0.505 mmol/L was identified as the optimal cutoff point to predict ISR. Patients were divided into 2 groups by RLP levels. After propensity score matching analysis, a total of 762 pairs matched patients were generated. Kaplan-Meier curves showed that the estimated cumulative rate of ISR was significantly higher in patients with RLP-C levels ≥ 0.505 mmol/L (log-rank P < 0.001; HR equal to 4.175, 95% CI = 3.045-5.723, P < 0.001) compared to patients with RLP-C levels < 0.505 mmol/L. CONCLUSIONS: The present study emphasized the importance of remnant-like particle cholesterol in cardiovascular pathology in diabetic patients. Physicians should take measures to control RLP-C below the level of 0.505 mmol/L to better prevent of in-stent restenosis in diabetic patients.
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Colesterol/sangre , Enfermedad de la Arteria Coronaria/cirugía , Reestenosis Coronaria/sangre , Diabetes Mellitus Tipo 2/sangre , Lipoproteínas/sangre , Intervención Coronaria Percutánea/efectos adversos , Triglicéridos/sangre , Anciano , Beijing/epidemiología , Biomarcadores/sangre , LDL-Colesterol/sangre , VLDL-Colesterol/sangre , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/sangre , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/epidemiología , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/instrumentación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Stents , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim is to evaluate the association between baseline platelet count (PC) and severe adverse outcomes following percutaneous coronary intervention (PCI) in current real-world practice. METHODS: A total of 18,788 patients underwent PCI with drug-eluting stents constituted the study population. Patients were categorized as having low (< 150 × 1000/µL), normal (150-300 × 1000/µL), and high (≥ 300 × 1000/µL) baseline PC. The primary endpoints included in-hospital and follow-up all-cause mortality. The secondary endpoint was major bleeding requiring a blood transfusion. RESULTS: In-hospital mortality rates for patients with low, normal, and high baseline PC were 0.6%, 0.4%, and 0.4%, respectively (P = 0.259). Similarly, mortality rates during long-term follow-up (median 23.8 months) for patients with low, normal, and high baseline PC were 0.9%, 0.6%, and 0.7%, respectively (P = 0.079). After multivariate adjustment, patients with low or high baseline PC tended to have similar risks for both in-hospital and follow-up mortality compared with the normal group. Subgroup analyses failed to demonstrate an independent prognostic value of baseline PC in specific population groups except patients who undwent transfemoral PCI. There was also no significant difference in the incidence of major bleeding requiring a blood transfusion in the low, normal, and high groups (0.5%, 0.3%, and 0.3%, respectively; P = 0.320). After multivariate adjustment, low or high baseline PC did not significantly increase the risk of major bleeding. CONCLUSION: There is no significant association between baseline PC and severe adverse outcomes following PCI in current real-world practice.
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BACKGROUND: Percutaneous coronary intervention (PCI) had become the major therapeutic procedure for coronary artery disease (CAD), but the high rate of in-stent restenosis (ISR) still remained an unsolved clinical problem in clinical practice. Increasing evidences suggested that diabetes mellitus (DM) was a major risk factor for ISR, but the risk predictors of ISR in CAD patients with DM had not been well characterized. The aim of this study was to investigate the clinical and angiographic characteristic predictors significantly associated with the occurrence of ISR in diabetic patients following coronary stenting with drug-eluting stent (DES). METHODS: A total of 920 patients with diabetes who diagnosed CAD and underwent coronary DES implantation at Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2012. Of these, 440 patients underwent the second angiography within ≥ 6 months due to the progression of treated target lesions. Finally, 368 of these patients who met the inclusion and exclusion criteria were followed up by angiography after baseline PCI. According to whether ISR was detected at follow-up angiography, patients were divided into the ISR group (n = 74) and the non-ISR group (n = 294). The independent predictors of ISR in patients with DM were explored by multivariate Cox's proportional hazards regression models. RESULTS: A total of 368 patients (260 women and 108 men) with a mean ages of 58.71 ± 10.25 years were finally enrolled in this study. Of these, ISR occurred in 74/368 diabetic patients (20.11%) by follow-up angiography. Univariate analysis showed that most baseline characteristics of the ISR and non-ISR group were similar. Patients in the ISR group had significantly higher serum very low density lipoprotein cholesterol (VLDL-C), triglyceride (TG) and uric acid (UA) levels, more numbers of target vessel lesions, higher prevalence of multi-vessel disease, higher SYNTAX score, higher rate of previous but lower rate of drinking compared with patients in the non-ISR group. The independent predictors of ISR in patients with DM after DES implantation included VLDL-C (HR = 1.85, 95% CI: 1.24-2.77, P = 0.002), UA (per 50 µmol/L increments, HR = 1.19, 95% CI: 1.05-1.34, P = 0.006), SYNTAX score (per 5 increments, HR = 1.34, 95% CI: 1.03-1.74, P = 0.031) and the history of PCI (HR = 3.43, 95% CI: 1.57-7.80, P = 0.003) by the multivariate Cox's proportional hazards regression analysis. CONCLUSIONS: The increased serum VLDL-C and UA level, higher SYNTAX score and the history of previous PCI were independent predictors of ISR in patients with DM after coronary DES implantation. It provided new evidence for physicians to take measures to lower the risk of ISR for the better management of diabetic patients after PCI.
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We conducted a meta-analysis of 13 randomized trials comparing the efficacy of rosuvastatin versus atorvastatin in reducing concentrations of C-reactive protein (CRP). We searched PubMed, Ovid, and Elsevier databases until June 2014. Search terms included C-reactive protein or CRP, rosuvastatin, atorvastatin, randomized, randomly, and randomization; 13 trials (3798 patients) were included. Funnel plots for CRP were inspected to assess publication bias. The pooled analysis demonstrated the benefit of rosuvastatin over atorvastatin therapy for all 13 trials (mean difference [MD] = -0.11, which is standardized mean with no unit although the raw data before pooling is mg/L, 95% confidence interval -0.15 to -0.07, P < .0001) with no evidence of significant publication bias (I(2) = 6.9%, P = .377). Subgroup analysis indicated a significant benefit of rosuvastatin over atorvastatin regarding the 1/1 dose ratio (MD = -0.14, 95% CI -0.21 to -0.06) and 1/2 dose ratio (MD= -0.11, 95% CI -0.16 to -0.05). Cumulative and influence analyses showed accuracy and stability for the estimation mentioned earlier. Our meta-analysis shows that rosuvastatin produces better reduction in CRP concentrations than atorvastatin at a dose ratio of 1/1 and 1/2 (rosuvastatin/atorvastatin), respectively.
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Antiinflamatorios/uso terapéutico , Atorvastatina/uso terapéutico , Proteína C-Reactiva/análisis , Enfermedades Cardiovasculares/prevención & control , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hiperlipidemias/tratamiento farmacológico , Lípidos/sangre , Rosuvastatina Cálcica/uso terapéutico , Adulto , Anciano , Antiinflamatorios/efectos adversos , Atorvastatina/efectos adversos , Biomarcadores/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Hiperlipidemias/sangre , Hiperlipidemias/diagnóstico , Hiperlipidemias/epidemiología , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Rosuvastatina Cálcica/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To observe the clinical efficacy of Shugan Yiyang Capsules in the treatment of asthenospermia and its action mechanisms. METHODS: We randomly assigned 135 asthenospermia patients to groups A (n = 47), B (n = 45), and C (n = 43) to be treated with Shugan Yiyang Capsules, oral levocarnitine, or combination of the two. We observed sperm quality and the level of α-glucosidase in the seminal plasma before and after medication. RESULTS: The total effectiveness rate was 70.21% in group A (markedly effective in 16 cases and effective in 17), 68.89% in group B (markedly effective in 15 cases and effective in 16), and 83.72% in group C (markedly effective in 16 cases and effective in 20), significantly higher in C than in A and B (P < 0.05). Both sperm quality and the level of α-glucosidase in the seminal plasma were improved in the three groups of patients, most obviously in group C. CONCLUSION: Shugan Yiyang Capsules can be used for the treatment of asthenospermia, and its effect can be enhanced in combination with oral levocarnitine.
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Astenozoospermia/tratamiento farmacológico , Carnitina/uso terapéutico , Medicamentos Herbarios Chinos/uso terapéutico , Astenozoospermia/enzimología , Investigación Biomédica , Cápsulas , Carnitina/administración & dosificación , Quimioterapia Combinada , Humanos , Masculino , Semen/enzimología , Espermatozoides , alfa-Glucosidasas/análisisRESUMEN
OBJECTIVE: To observe the relaxant effect of Aike Mixture (AKM) on isolated bladder and prostatic urethral smooth muscle of rabbits. METHODS: The isolated bladder and prostatic urethral smooth muscle from male rabbits were placed in a Magnus bath and smooth muscle contraction was measured using a biological signal acquisition and analysis system. The effects of AKM in combination with methoxyamine, carbachol and CaCl2 on the contractile tension of muscle strips were determined by cumulative dosing. RESULTS: AKM dose-dependently reduced contractile tension of bladder trigone smooth muscle (r=0.831, P<0.05), reduced contractile wave amplitude (r=0.837, P<0.05) and decreased contractile frequency (r=-0.917, P<0.01). AKM significantly inhibited the increases in smooth muscle contraction induced by methoxyamine, carbachol and CaCl2. CONCLUSION: AKM dose-dependently inhibited the contraction of rabbit isolated bladder and prostatic urethral smooth muscle by antagonizing α1-adrenergic receptors and M-cholinergic receptors.
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Medicamentos Herbarios Chinos/farmacología , Músculo Liso/fisiología , Fármacos Neuromusculares/farmacología , Próstata/fisiología , Uretra/fisiología , Vejiga Urinaria/fisiología , Animales , Cloruro de Calcio/farmacología , Carbacol/farmacología , Hidroxilaminas/farmacología , Técnicas In Vitro , Masculino , Contracción Muscular/efectos de los fármacos , Músculo Liso/efectos de los fármacos , Próstata/efectos de los fármacos , Conejos , Receptores Adrenérgicos alfa 1/metabolismo , Receptores Muscarínicos/metabolismo , Uretra/efectos de los fármacos , Vejiga Urinaria/efectos de los fármacosRESUMEN
BACKGROUND: The radial approach has been increasingly used as an alternative to femoral access. And more procedures using repeated transradial coronary intervention (r-TRI) are performed. However, few data about r-TRI has been obtained. Therefore, we investigated the safety and feasibility of r-TRI using the same route. METHODS: A total of 423 consecutive eligible patients undergoing r-TRI were enrolled in the r-TRI group, and 846 patients with initial TRI (i-TRI) were assigned to the i-TRI group in a 2:1 matching ratio compared to r-TRI group. The primary endpoint included the success rate of the procedure and the incidence of vascular related complications. RESULTS: The baseline clinical characteristics in the two groups were comparable. The success rate of procedures in the r-TRI and i-TRI was similar (96.0% vs. 97.5%, P = 0.130). In subgroup analysis (coronary angiography only or angiography with pecutaneous coronary intervention), similar results were also observed. The puncture numbers and incidence of radial artery spasm in the r-TRI group were significantly higher than in the i-TRI group (P = 0.024 and P < 0.001, respectively). The other procedural outcomes in the two groups were identical. With respect to the incidence of overall vascular related complication and independent events, there were no significant differences in spite of a higher incidence of radial artery occlusion (RAO) in the r-TRI group (RAO: 1.2% vs. 0.7%, P = 0.521). The patients in the i-TRI group had more comfortable feeling than patients in the r-TRI group (P = 0.001). CONCLUSIONS: R-TRI produces a comparable procedure success rate and incidence of vascular complication when compared to i-TRI. It should be considered as an acceptable and safe procedure.
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Angioplastia Coronaria con Balón/efectos adversos , Angioplastia Coronaria con Balón/métodos , Adulto , Anciano , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To observe the effect of Aike Mixture (AKM) on prostatic inflammatory infiltration in patients with chronic prostatitis type III A (III A-CP/CPPS) and evaluate its anti-inflammatory action. METHODS METHODS: A total of 60 patients with III A-CP/CPPS suitable to operation and differentiated as Chinese medicine: Gan qi stagnancy syndrome type were selected. They were assigned with the random number table to two groups equally. Before operation, the patients in the treated group were administered with Proscar combined with AKM, but those in the control group treated with Proscar only. Suprapubic transvesical prostatectomy was performed two weeks later, and prostatic pathological examination was conducted. RESULTS: Grading of: inflammatory cell infiltration showed that the mean grade in the treated group was 0.78 ± 0.90 grades, which was significantly lower than that in the control group 1.68 ± 0.87 grades (P<0.05). However, the two groups were not different in the grades of fibroblast proliferation (1.50 ± 0.70 grades vs 1.62 ± 0.87 grades, P>0.05). CONCLUSION: AKM could suppress the inflammatory cell infiltration, be an effective and safe remedy for the treatment of IIIA-CP/CPPS of Gan-qi stagnancy syndrome type, and worthy for spreading in clinical use.
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Medicamentos Herbarios Chinos/uso terapéutico , Inflamación/tratamiento farmacológico , Inflamación/patología , Prostatitis/tratamiento farmacológico , Prostatitis/patología , Anciano , Enfermedad Crónica , Medicamentos Herbarios Chinos/efectos adversos , Fibroblastos/patología , Humanos , Hiperplasia , Masculino , Persona de Mediana Edad , Prostatitis/clasificaciónRESUMEN
OBJECTIVE: To compare the effects of elastic bandage compression with the specific hemostasis devices in patients undergoing transradial coronary intervention. METHODS: A total of 3000 consecutive patients were randomized to 3 groups and 2910 patients completed the study, 963 patients in elastic bandage group (ER), 976 in T band group (TB) and 971 in balloon group (TR). In-hospital vascular related complication was the primary study endpoint. The secondary endpoints included: risk factors of complications, compression time, fibroplasia conditions and the comfort feeling of patients. RESULTS: The overall incidence of vascular related complication in 3 groups was similar (P = 0.262). Female, low body weight, prolongation of procedure and multi-punctures were identified as the independent risk factors for complications. Moreover, the compression time and the fibroplasia condition in TB and TR group were superior to those in the ER group. Comfortable feeling of the patients was better in TR and TB group than in ER group (P < 0.001). CONCLUSIONS: Both conventional bandage device and specific radial device are feasible and associated with low incidence of vascular complication. However, the specific radial device has significant advantage over bandage strategy in compression time and quality of life.
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Técnicas Hemostáticas/instrumentación , Hemorragia Posoperatoria/prevención & control , Adulto , Anciano , Angioplastia Coronaria con Balón/métodos , Vendajes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Arteria Radial , Resultado del TratamientoRESUMEN
OBJECTIVE: To explore the feasibility and safety of T stenting and small protrusion (TAP) technique and compare the efficacy with simple stenting in patients with coronary bifurcation lesions and with big size side branch. METHODS: A total of 142 eligible patients were recruited and 127 patients completed the study (simple stenting group 58 and TAP technique group 69). RESULTS: Major adverse cardiovascular event rate was similar at 12 months follow up between the groups (TAP technique group 13.0% versus simple stenting group 12.1%, P > 0.05). The rate of procedural-related myocardial infarction, procedure and fluoroscopy time, contrast volumes were also similar between 2 groups (all P > 0.05). At 8 months, coronary angiography revealed that the restenosis rate of the ostium of side branch in TAP group was significantly lower than that of simple stenting group (17.1% versus 3.8%, P < 0.05). Overall restenosis rate was similar between the groups (P > 0.05). CONCLUSION: Both TAP technique and simple stenting are feasible and effective strategies for treating patients with bifurcation lesions.
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Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/terapia , Stents , Adulto , Anciano , Vasos Coronarios/patología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We evaluated the transcatheter intervention of complex patent ductus arteriosus (PDA) in Chinese adults. Between January 2004 and April 2008, 112 adult patients (43 males, 69 females, mean age 31 +/- 19 years) underwent intervention. Coils were used for patients with small PDA, and Amplatzer duct occluders or China-made mushroom-shaped occluders were used for patients with moderate-to-large PDA. The success rate of transcatheter intervention was 93.8%, and 9 patients (8.0%) had small residual shunts. At the end of 12 months follow-up, the rate of residual shunts was 1.8%. Peak systolic pulmonary pressure decreased from 94 +/- 21 mm Hg preintervention to 58 +/- 20 mm Hg postintervention (P < .001). No severe procedure-related complications (including death, dislocation of occluders, stenosis of aorta or pulmonary artery) occurred. Some patients developed hemolysis or vascular access complications, all resolved by conservative therapy. Transcatheter intervention is an effective and safe treatment for adult PDA patients with complex anatomic or hemodynamic conditions.
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Cateterismo Cardíaco/instrumentación , Conducto Arterioso Permeable/terapia , Adolescente , Adulto , Factores de Edad , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/métodos , Niño , China , Estudios de Cohortes , Conducto Arterioso Permeable/patología , Conducto Arterioso Permeable/fisiopatología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Diseño de Prótesis , Estudios Retrospectivos , Dispositivo Oclusor Septal , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To observe the effects of upstream versus downstream application of tirofiban on platelet aggregation and clinical outcomes (major adverse cardiovascular event, MACE) in patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). METHODS: From July 2006 to July 2007, 160 high-risk NSTE-ACS patients undergoing PCI were randomized to receive upstream (4-6 h prior PCI) tirofiban and downstream (immediately prior to PCI) tirofiban. Platelet aggregation inhibition was determined at admission, before coronary angiography and after PCI. Incidences of MACE at 1, 3, 7, 30 and 180 days after PCI were compared. The incidences of bleeding complications and thrombocytopenia during tirofiban treatments were recorded. RESULTS: The extent of platelet aggregation inhibition post tirofiban was significantly greater in upstream tirofiban than that in downstream tirofiban group (8% vs. 42%, P<0.05). The incidences of MACE at various time points were similar between the two groups (all P>0.05). Aging, hypertension and type-2 diabetes were independent risk factors of MACE. The incidences of major and minor bleeding complications as well as mild thrombocytopenia during tirofiban treatments were similar between the two groups (2.5% vs. 1.3%, 1.3% vs. 1.3% and 1.3% vs. 1.3%, respectively; all P>0.05). CONCLUSION: On top of aspirin and clopidogrel, upstream application of tirofiban is associated with increased platelet aggregation inhibition but the incidences of MACE up to 180 days post tirofiban are similar in the upstream and downstream tirofiban treated patients with high-risk NSTE-ACS after PCI. Aging, hypertension and type-2 diabetes were independent risk factors of MACE in these patients.
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Síndrome Coronario Agudo/tratamiento farmacológico , Enfermedades Cardiovasculares/etiología , Inhibidores de Agregación Plaquetaria/uso terapéutico , Tirosina/análogos & derivados , Síndrome Coronario Agudo/terapia , Adulto , Anciano , Angioplastia Coronaria con Balón , Clopidogrel , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Factores de Riesgo , Ticlopidina/análogos & derivados , Ticlopidina/uso terapéutico , Tirofibán , Resultado del Tratamiento , Tirosina/uso terapéuticoRESUMEN
OBJECTIVE: To compare the 2 years outcome of elderly patients with ULMCA stenosis undergoing coronary artery bypass grafting (CABG) or drug eluting stent (DES). METHODS: From January 2004 to June 2006, 295 patients with ULMCA stenosis and age > or = 70 years undergoing coronary revascularization with either CABG (n = 206) or DES (n = 89) were enrolled in this analysis. All-cause death, non-fatal myocardial infarction and target lesion revascularization (TLR) were recorded during 2 years follow-up. RESULTS: The cumulative rate of 2-year mortality were 10.2% (n = 21) in CABG-treated patients and 13.3% (n = 12) in DES-treated patients (P = 0.428). The survival rate during 2-year follow-up was 89.2% for CABG-treated patients and 86.4% for DES-treated patients (P = 0.668). The incidence of 2-year myocardial infarction was 7.8% (n = 16) in CABG-treated patients and 10.1% (n = 9) in DES-treated patients (P = 0.501). The incidence of target lesion revascularization (TLR) was 4.9% (n = 10) in CABG-treated patients and 13.5% (n = 12) in DES-treated patients (P = 0.015). In the multivariable analysis, age (HR: 1.04, 95% CI: 1.01-1.09, P = 0.024), left ventricular dysfunction (ejection fraction < 30%, HR: 4.97, 95% CI: 1.22-24.85, P = 0.018) and type 2 diabetes (HR: 2.22, 95% CI: 1.31-4.86, P = 0.001) were independent predictors of 2-year mortality. CONCLUSION: In this study, 2-year mortality was comparable in elderly patients with ULMCA stenosis underwent CABG or DES. However, the rate of TLR was significantly higher in patients treated with DES than that receiving CABG operation.
Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Humanos , Masculino , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the safety and feasibility of transradial coronary angiography at the outpatient clinic. METHODS: From February 2007 to June 2007, 100 outpatients who received transradial coronary angiography in Anzhen hospital were included in this analysis, 100 inpatients underwent coronary angiography were selected as control group. Primary endpoints included success rate, percent of angiographic catheter use with different diameters, adverse events during the procedure (such as death, malignant arrhythmia, acute myocardial infarction, coronary artery spasm, coronary artery dissection, perforation or occlusion, etc.) and after the procedure (such as death, acute myocardial infarction, upper limb haematoma, osteofascial compartment syndrome, radial artery pseudoaneurysm or occlusion, etc.). RESULTS: The success rate (100% vs. 100%), procedure duration time [(12.5 +/- 3.4) min vs.(10.8 +/- 3.6) min, P = 0.517] and exposition time [(4.3 +/- 1.0) min vs. (4.1 +/- 1.0) min, P = 0.629] were similar between the outpatient and inpatient groups. Radial and coronary artery spasm were the main adverse events during the angiography, and haematoma was the main adverse event after the angiography. There were no significant differences of adverse events between the 2 groups. The total cost of the outpatient group was significantly lower than the inpatient control group [(4012 +/- 238) yuan vs. (5329 +/- 371) yuan, P < 0.001]. Expenditure including chemical tests, medicine, nursing care, room and board all decreased significantly. CONCLUSION: Transradial coronary angiography application at the outpatient clinic was safe and feasible for stable patients, and this procedure could decrease the medical expenditure and shorten the admission time.
Asunto(s)
Atención Ambulatoria/métodos , Angiografía Coronaria/métodos , Atención Ambulatoria/economía , Estudios de Casos y Controles , China , Angiografía Coronaria/efectos adversos , Estudios de Factibilidad , Gastos en Salud/estadística & datos numéricos , Mortalidad Hospitalaria , Humanos , Tiempo de Internación/estadística & datos numéricosRESUMEN
OBJECTIVES: This study was undertaken to compare the renal safety as well as cardiovascular (CV) effects and diagnostic image quality of iso-osmolar iodixanol vs. low-osmolar iopromide in patients with chronic kidney disease (CKD) undergoing coronary interventions. BACKGROUND: With the growing number of contrast-enhanced procedures being performed for coronary artery disease management, the safety and efficacy of iodinated contrast media (CM) have come under increased scrutiny. METHODS: : Patients with CKD (CrCl < or =60 mL/min) were randomized to iodixanol (n = 106) or iopromide (n = 102). The primary endpoint was incidence of contrast-induced nephropathy (CIN), defined as an increase in serum creatinine (SCr) > or =25% or 0.5 mg/dL within 72 hr of CM administration. Secondary endpoints were mean SCr increase, a composite of CV events in-hospital and 30 days postdischarge, and diagnostic image quality. RESULTS: : CIN incidence was significantly lower with iodixanol than iopromide (5.7% vs. 16.7%; P = 0.011). Baseline SCr (OR 2.21, 95% CI: 1.25-3.47; P = 0.031), iopromide use (OR 2.56, 95% CI: 1.18-5.76; P = 0.024), and CM volume (OR 2.01, 95% CI: 1.01-3.21; P = 0.038) were identified as independent risk factors for CIN. Cardiovascular events were reduced with iodixanol (1.9% vs. 8.8%; P = 0.025); diagnostic image quality was similar for both CM (P = 0.353). CONCLUSIONS: : Consistent with several previous trials comparing iso-osmolar iodixanol and low-osmolar comparator CM, iodixanol was associated with a lower incidence of CIN and fewer CV events than iopromide.
Asunto(s)
Lesión Renal Aguda/inducido químicamente , Angioplastia Coronaria con Balón , Enfermedades Cardiovasculares/inducido químicamente , Medios de Contraste/efectos adversos , Angiografía Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Yohexol/análogos & derivados , Enfermedades Renales/complicaciones , Ácidos Triyodobenzoicos/efectos adversos , Lesión Renal Aguda/fisiopatología , Lesión Renal Aguda/terapia , Anciano , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/terapia , Creatinina/sangre , Método Doble Ciego , Femenino , Humanos , Yohexol/efectos adversos , Enfermedades Renales/fisiopatología , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Interpretación de Imagen Radiográfica Asistida por Computador , Diálisis Renal , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Transradial coronary intervention has been widely used because of its effects in lowering the incidence of complications in vascular access site and improving patient satisfaction compared to the femoral approach. This study aimed to investigate the safety and feasibility of transradial approach for primary percutaneous coronary intervention (PCI) in elderly patients with acute myocardial infarction (AMI). METHODS: A total of 103 consecutive elderly patients (age = 65 years) who were diagnosed as having AMI were indicated for PCI. Among them, 57 patients received primary PCI via the transradial approach (transradial intervention, TRI group), and 46 underwent primary PCI via the transfemoral approach (transfemoral intervention, TFI group). The success rate of puncture, puncture time, cannulation time, reperfusion time, the total time for PCI, the success rate of PCI, the use rates of temporary pacemaker and intra-aortic balloon pump (IABP), and the total length of hospital stay of the patients in the two groups were compared. After the procedure, vascular access site complications and major adverse cardiovascular events (MACE) in the two groups in one month were observed. RESULTS: The success rates of puncture (98.2% vs 100.0%) and PCI (96.5% vs 95.7%) for the patients in the TRI and TFI groups were not statistically significant (P > 0.05). The puncture time ((2.4 +/- 1.1) vs (2.0 +/- 0.9) minutes), cannulation time ((2.7 +/- 0.5) vs (2.6 +/- 0.5) minutes), reperfusion time ((16.2 +/- 4.5) vs (15.4 +/- 3.6) minutes), total time of the procedure ((44.1 +/- 6.8) vs (41.2 +/- 5.7) minutes), use rates of temporary pacemaker (1.8% vs 2.2%) and IABP (0 vs 2.2%) in the two groups were not statistically significant (P > 0.05), but the hospital stay of the TFI group was longer than that of the TRI group ((10.1 +/- 4.6) vs (7.2 +/- 2.6) days, P < 0.01). A radial occlusion was observed in the TRI group, but no ischemic syndrome in hand. In the TFI group, 4 patients had hematosis, 1 had pseudoaneurysm, and 1 had major bleeding. Statistical significance in vascular access site complications was seen in the two groups (1.8 % vs 13.1%, P < 0.05). Three patients died in the two groups respectively in one month, and there was no statistical significance in MACE in the two groups (5.3% vs 6.5%, P > 0.05). CONCLUSION: The transradial approach for primary PCI is safe and feasible for elderly patients with AMI.