Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive pa...Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.展开更多
目的比较早期经皮冠状动脉介入(PCI)与延迟PCI策略对高危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)12个月临床终点的影响。方法连续收集自2015年1月1日至2015年12月31日在武汉亚洲心脏病医院行PCI治疗的高危NSTE-ACS患者758例,并依据...目的比较早期经皮冠状动脉介入(PCI)与延迟PCI策略对高危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)12个月临床终点的影响。方法连续收集自2015年1月1日至2015年12月31日在武汉亚洲心脏病医院行PCI治疗的高危NSTE-ACS患者758例,并依据介入治疗时间窗分为早期PCI组(确诊后24 h内PCI,185例)和延迟PCI组(确诊后超过24 h PCI,573例),主要终点是术后12个月主要不良心血管事件(MACE),包括全因死亡与再发非致死性心肌梗死。回顾性对比分析两组基线临床资料、冠状动脉影像特征、PCI相关数据以及主要终点。结果 711例(93.8%)患者完成12个月随访。早期PCI组主要终点MACE发生率与延迟PCI组比较差异无统计学意义(14.5%比11.2%,χ~2=1.289,P=0.256),全因死亡与再发非致死性心肌梗死两组比较,差异均无统计学意义(均P>0.05)。早期PCI组显著降低住院时间[(7.6±3.1)d比(10.7±3.8)d,t=2.489,P=0.014)]及减少医疗费用[(4.85±1.35)万元比(5.28±1.64)万元,t=2.132,P=0.038)]与延迟PCI组比较,差异均有统计学意义。结论早期介入干预不能降低高危NSTE-ACS患者PCI术后12个月MACE发生率,但能缩短住院时间,减少医疗费用。展开更多
<strong>Introduction:</strong> <span style="font-family:Verdana;">Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions...<strong>Introduction:</strong> <span style="font-family:Verdana;">Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Smoking may increase the thrombus burden in patients with acute coronary syndrome. The </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">smoker’s paradox</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> has been described for more than 25 years. Its existence and its effect on patients’ outcome post-myocardial infarction are debatable</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;"><b>Methods: </b></span><span style="font-family:Verdana;">Our prospective observational study was conducted from-August 2018 to August 2019 on STEMI patients with the duration from onset of symptoms to first medical contact were 12 hours or less. We included 199 patients in our study.</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">Patients are divided into 4 groups </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">1</span></u></b></span><span style="font-family:Verdana;"><b> </b></span><span style="font-family:;" "=""><span style="font-family:Verdana;">(Smokers treated by PPCI) </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">2</span></u></b><span style="font-family:Verdana;"> (Non-smokers treated by</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;"> PPCI) </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">3</span></u></b><span style="font-family:Verdana;"> (Smoker treated by pharmaco-inva展开更多
目的了解非ST段抬高急性冠状动脉综合征(ACS)患者在住院当日行经皮冠状动脉介入治疗(PCI)的安全性和住院临床结果。方法 SUNDAY(Strategies for UA／NSTEMI and Delay of AngioplastY)为单中心回顾性注册研究,入选2000年1月至2002年12月...目的了解非ST段抬高急性冠状动脉综合征(ACS)患者在住院当日行经皮冠状动脉介入治疗(PCI)的安全性和住院临床结果。方法 SUNDAY(Strategies for UA／NSTEMI and Delay of AngioplastY)为单中心回顾性注册研究,入选2000年1月至2002年12月3年间首次因非ST段抬高急性冠脉综合征在本院住院的1013例患者,记录患者的临床特点、治疗经过以及住院心血管事件等情况。本研究选择SUNDAY注册中冠状动脉造影后接受PCI的患者,比较当日(≤24 h)PCI和入院24 h以后行PCI的安全性和住院临床结果。结果在SUNDAY注册的1013例患者中,共有438例患者入院后接受冠状动脉造影和PCI。35例和 403例分别于入院≤24 h(当日PCI组)和24 h以后(非当日PCI组)行PCI。两组基础临床特征基本相似。当日PCI组和非当日PCI组分别在入院后(22±7)h和(142±152)h行冠状动脉造影(P<0．01),两组分别于入院后(1．0±0．0)d和(7．5±7．3)d行PCI(P<0．01),PCI成功率分别为97．1％与97．0％(P> 0．05)。完全血管重建率分别为62．9％与53．6％(P>0．05)。两组住院期间均无死亡,住院新发心肌梗死发生率分别为2．9％与1．2％(P:0．395),再次血管重建率分别为0与0．2％(P>0．05),主要不良心脏事件 (包括死亡、新发心肌梗死、再次血管重建)发生率分别为2．9％与1．5％(P>0．05)。当日PCI组的住院时间分别为(7．7±3．0)d与(15．2±9．8)d(P<0．01),住院费用分别为(6．1±2．3)万元与(6．4±3．1)万元(P=0．582)。结论非ST段抬高急性冠脉综合征患者在住院当日接受冠状动脉造影并行PCI安全可行, 其成功率较高,临床事件发生率较低,能显著缩短住院日,并有降低住院费用的趋势。展开更多
文摘Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
文摘目的比较早期经皮冠状动脉介入(PCI)与延迟PCI策略对高危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)12个月临床终点的影响。方法连续收集自2015年1月1日至2015年12月31日在武汉亚洲心脏病医院行PCI治疗的高危NSTE-ACS患者758例,并依据介入治疗时间窗分为早期PCI组(确诊后24 h内PCI,185例)和延迟PCI组(确诊后超过24 h PCI,573例),主要终点是术后12个月主要不良心血管事件(MACE),包括全因死亡与再发非致死性心肌梗死。回顾性对比分析两组基线临床资料、冠状动脉影像特征、PCI相关数据以及主要终点。结果 711例(93.8%)患者完成12个月随访。早期PCI组主要终点MACE发生率与延迟PCI组比较差异无统计学意义(14.5%比11.2%,χ~2=1.289,P=0.256),全因死亡与再发非致死性心肌梗死两组比较,差异均无统计学意义(均P>0.05)。早期PCI组显著降低住院时间[(7.6±3.1)d比(10.7±3.8)d,t=2.489,P=0.014)]及减少医疗费用[(4.85±1.35)万元比(5.28±1.64)万元,t=2.132,P=0.038)]与延迟PCI组比较,差异均有统计学意义。结论早期介入干预不能降低高危NSTE-ACS患者PCI术后12个月MACE发生率,但能缩短住院时间,减少医疗费用。
文摘<strong>Introduction:</strong> <span style="font-family:Verdana;">Smoking is a common public problem with a high health burden. Many studies have shown that there are many hazardous actions of smoking on body systems especially haemostatic, respiratory and circulatory systems.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">Smoking may increase the thrombus burden in patients with acute coronary syndrome. The </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">smoker’s paradox</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> has been described for more than 25 years. Its existence and its effect on patients’ outcome post-myocardial infarction are debatable</span><span style="font-family:Verdana;">. </span><span style="font-family:Verdana;"><b>Methods: </b></span><span style="font-family:Verdana;">Our prospective observational study was conducted from-August 2018 to August 2019 on STEMI patients with the duration from onset of symptoms to first medical contact were 12 hours or less. We included 199 patients in our study.</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">Patients are divided into 4 groups </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">1</span></u></b></span><span style="font-family:Verdana;"><b> </b></span><span style="font-family:;" "=""><span style="font-family:Verdana;">(Smokers treated by PPCI) </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">2</span></u></b><span style="font-family:Verdana;"> (Non-smokers treated by</span></span><span style="font-family:;" "=""><span style="font-family:Verdana;"> PPCI) </span><b><i><u><span style="font-family:Verdana;">Group </span></u></i><u><span style="font-family:Verdana;">3</span></u></b><span style="font-family:Verdana;"> (Smoker treated by pharmaco-inva
