Objective To evaluate the efficacy of statins pretreatment in patients before percutaneous coronary intervention (PCI). Methods Published literature on relevant randomized controlled trials (RCTs) were retrieved via electronic and handsearch in databases CNKI, CBM, MEDLINE and The Cochrane Library from January 1990 to May 2011. The references of these articles were also retrieved. Two reviewers independently identified articles according to the inclusion and exclusion criteria, extracted the data, assess the quality of the included studies, and then conducted meta-analysis using RevMan 5.0 software. Results A total of 10 trials involving 3 012 patients were included. The results of meta-analyses showed that: during the periprocedural period, the trial group had a lower incidence than the control group (98 of 1 514 cases, incidence 6.5%) in periprocedural myocardial infarction with a significant difference (OR=0.43, 95% CI 0.34 to 0.56, Plt;0.000 01). The composite of death, myocardial infarction, or target vessel revascularization in one month, essentially driven by periprocedural myocardial infarction, was reported 6.8% in the trial group and 15.1% in the control group (OR=0.41, 95% CI 0.32 to 0.53, Plt;0.000 01). Conclusion Current evidence supports the effectiveness of statin pretreatment used to reducing the rate of periprocedural myocardial infarction in patients before receiving PCI.
ObjectiveTo investigate the effect of Glycerine Enema on patients with urinary retention after coronary interventional procedures. MethodsBetween October 2011 and October 2012, 100 patients with urinary retention after coronary intervention were randomized into experimental group (enema group) and control group (conventional treatment group). The clinical effect of the two methods were compared between the two groups. ResultsThe effective rate in the experimental group was 88.0% while in the control group was 54.0%, and the difference between the two groups was statistically signifi cant (P<0.05). ConclusionThe effect of Glycerine Enema on patients with urinary retention after coronary intervention is obvious and signifi cant.
ObjectiveTo summarize our experience of emergency coronary artery bypass grafting (CABG) for the treatment of coronary accidents during percutaneous coronary intervention (PCI). MethodsFrom January 2011 to January 2013, 30 patients with coronary accidents during PCI from our hospital and other hospitals received surgical treatment in Xinhua Hospital, Medical School of Shanghai Jiaotong University. There were 21 male and 9 female patients with their age of 68±11 (54-84) years. Coronary accidents included coronary artery dissection in 12 patients, coronary artery perforation in 12 patients, acute in-stent thrombosis in 2 patients, dilation balloon rupture in 1 patient and balloon retention in 1 patient, and PCI guidewire retention in 2 patients. Among the 30 patients, 8 patients received intra-aortic balloon pump (IABP) implantation preoperatively. All the patients underwent emergency CABG, including 29 patients undergoing off-pump CABG and 1 patient undergoing CABG on pump with heart beating. The patients' medical history, PCI and surgical records were retrospectively reviewed, and surgical treatment strategies, clinical outcomes and prognosis were summarized. ResultsThe average number of grafts was 2.8±0.4. Postoperative length of ICU stay was 8.3±4.8 days, and mean hospital stay was 20.3±15.2 days. Postoperative complications included low cardiac output syndrome (LCOS) in 3 patients, tracheotomy in 2 patients, acute renal failure requiring continuous renal replacement therapy in 2 patients, and reexploration for bleeding in 1 patient. Twenty-eight were discharged, 1 patient died of multiple organ dysfunction syndrome caused by LCOS, and another patient died of refractory ventricular fibrillation. A total of 26 patients were followed up for 10.2±8.3 months and 1 patient died of stroke during the following up. ConclusionEmergency CABG can restore coronary artery blood flow quickly and provide good results for coronary accidents during PCI.
Objective To systematically review the efficacy and safety of minimally invasive direct coronary artery bypass (MIDCAB) grafting versus percutaneous coronary intervention (PCI) for patients with single-vessel disease of the left anterior descending artery (LAD). Methods Databases including The Cochrane Library (Issue 2, 2015), PubMed, EMbase, CBM, CNKI, WanFang Data and VIP were searched electronically from inception to Oct. 2015, to collect randomized controlled trials (RCTs) about MIDCAB versus PCI for single-vessel disease of the LAD. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of 10 RCTs including 1 489 patients were included. The results of meta-analysis showed that: compared with the PCI group, the MIDCAB group could significantly reduce the incidence of postoperative target vessel revascularization (OR=0.20，95%CI 0.13 to 2.29，P < 0.000 01), and the incidence of main adverse cardiovascular and cerebrovascular events (MACCE) (OR=0.44, 95%CI 0.33 to 0.58, P < 0.000 01). No significant differences were found between the two groups in total case mortality (OR=1.23, 95%CI 0.83 to 1.83, P=0.31), cardiogenic death (OR=1.12, 95%CI 0.59 to 2.12, P=0.73), and the incidence of postoperative myocardial infarction (OR=2.16, 95%CI 0.83 to 5.59, P=0.11). Conclusion In reducing the incidences of postoperative target vessels again revascularization and MACCE of patients with single-vessel disease of the LAD, MIDCAB is superior to PCI. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality RCTs.
Objective To compare the clinical efficacy of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with coronary heart disease and left ventricular systolic dysfunction. Methods A computer-based search in PubMed, The Cochrane Library and EMbase up to October 2017, together with reference screening, was performed to identify eligible clinical trials, cohort studies and case-control studies. The outcomes of this meta-analysis included all-cause mortality, myocardial infarction, revascularization and stroke, and the effect sizes for them were presented as relative risk (RR) with its 95% confidence intervals (CI). Results Fifteen cohort studies and 2 randomized controlled trials were finally included with a total of 11 985 patients, of whom 6 322 were in the CABG group and 5 663 in the PCI group. The result of meta-analysis showed that all-cause mortality was significantly lower in the CABG group than that in the PCI group (18.6% vs. 23.0%, RR=0.87, 95% CI 0.81 to 0.94, P<0.001). In addition, CABG was associated with a remarkably reduced risk of revascularization (RR=0.28, 95% CI 0.19 to 0.42, P<0.001) compared with PCI, with no significant difference in incidence of myocardial infarction (RR=0.78, 95% CI 0.47 to 1.32, P=0.36) and stroke (RR=1.28, 95% CI 0.89 to 1.86, P=0.18). Conclusion CABG is superior to PCI in the treatment for patients with coronary heart disease and left ventricular systolic dysfunction. Owing to the limited quality of included studies, additional large, randomized controlled trails are still required to confirm this finding.
ObjectivesTo evaluate the efficacy and safety of four antiplatelet regimens after coronary drug-eluting stents by network meta-analysis.MethodsPubMed, The Cochrane Library, EMbase and Web of Science databases were electronically searched to collect randomized controlled trials (RCTs) of the comparison of different antiplatelet regimens after coronary drug-eluting stenting from inception to December 31st, 2019. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. Network meta-analysis was then performed by using Gemtc14.3 software, Stata16.0 software and RevMan5.3 software.ResultsA total of 23 RCTs involving 45 837 patients were included. The results of network meta-analysis showed that: in terms of prevention of myocardial infarction (MI) recurrence, the aspirin monotherapy after short-term dual antiplatelet therapy was inferior to the triple antiplatelet therapy (OR=2.13, 95%CI 1.08 to 4.03). In terms of reducing the incidence of ischemic compound events, the triple antiplatelet therapy was superior to the standard dual antiplatelet therapy (OR=0.53, 95%CI 0.39 to 0.72), the aspirin monotherapy after short-term dual antiplatelet therapy (OR=0.49, 95%CI 0.35 to 0.69) and the P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy (OR=0.51, 95%CI 0.35 to 0.73). There was no statistically significant difference among the four interventions in reducing the rate of in-stent thrombosis and all-cause mortality (P>0.05). In terms of safety, the bleeding rate of aspirin monotherapy after short-term dual antiplatelet therapy was lower than that of standard dual antiplatelet therapy (OR=0.70, 95%CI 0.55 to 0.86) and triple antiplatelet therapy (OR=0.58, 95%CI 0.36 to 0.90), and the bleeding rate of P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was also lower than that of standard dual antiplatelet therapy (OR=0.51, 95%CI 0.39 to 0.65) and triple antiplatelet therapy (OR=0.43, 95%CI 0.26 to 0.67). The probability ranking diagram showed that: in terms of the recurrence rate of MI, the rate of in-stent thrombosis and the incidence of ischemic compound events, triple antiplatelet therapy was the lowest and aspirin monotherapy after short-term dual antiplatelet therapy was the highest. However, in terms of all-cause mortality and bleeding rate, aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy was the lowest and triple antiplatelet therapy was the highest.ConclusionsThe available evidence suggests that when the risk of ischemia is low, we should choose aspirin or P2Y12 inhibitor monotherapy after short-term dual antiplatelet therapy, and P2Y12 inhibitor monotherapy may have a lower risk of ischemia and bleeding. When the risk of ischemia is high and bleeding is low, the triple or standard dual antiplatelet therapy should be selected, and the efficacy of triple antiplatelet therapy is superior, while the safety may be inferior.
Hybrid coronary revascularization (HCR) combines the advantages of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI), and avoids its relative shortcomings, which has received particular attention in recent years. HCR seems to have become the third revascularization strategy for multi-vessel disease in coronary heart diseases. However, the clinical researches on HCR are still limited. This article will systematically review the comparison of HCR with coronary artery bypass grafting (CABG) and PCI, the results of HCR in specific patients, and the clinical results of different HCR strategies.
ObjectiveTo investigate the influencing factors of serum NT-proBNP level in elderly patients with acute myocardial infarction (AMI) after PCI, and to analyze its predictive value for the short-term prognosis of patients. MethodsA total of 98 elderly patients with AMI in Zhengzhou central hospital from May 2020 to August 2022 were selected, all of whom underwent PCI. The level of serum NT-proBNP before and after PCI was detected. The level of serum NT-probNP after PCI was ≥125 pg/mL, and the level of serum NT-probNP after PCI was normal. Univariate analysis of the general data of the elevated NT-proBNP group and the normal group, Lasso regression model was used to screen the screening variables, and Logistic regression was used to analyze the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The prognosis recovery of patients with different NT-proBNP and the level of NT-proBNP in patients with different prognosis were compared and analyzed. ROC curve was drawn to analyze the predictive value of NT-proBNP level in patients with short-term prognosis after PCI. ResultsLogistic regression analysis showed that the time from onset to PCI, age, left ventricular ejection fraction (LVEF), stroke, number of stents implanted, no recirculation and stent diameter were the influencing factors of serum NT-proBNP level in elderly AMI patients after PCI. The incidence of adverse cardiovascular events (MACE) was 21.43% (21/98) in 98 patients followed up 6 months after surgery, and the incidence of NT-proBNP increased group was 68.00% (17/25), which was significantly higher than that of normal group (5.48% (4/73) (P<0.05). The level of NT-proBNP in the group with MACE was significantly higher than that in the group without MACE (P<0.05). ROC curve showed that AUC was 0.813 (95%CI 0.721 to0.884), sensitivity and specificity were 80.95% and 79.22%, respectively, suggesting that serum NT-proBNP level after PCI had certain predictive value for short-term prognosis of patients. ConclusionSerum NT-proBNP level in elderly AMI patients after PCI has a good ability to predict the short-term prognosis of patients. Comprehensive consideration of the number of stents inserted, the presence of stroke, the presence of reflow and age and other factors to strengthen the monitoring of NT-proBNP level is helpful to prevent and control the occurrence of MACE, so as to improve the prognosis of patients.