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INTERVENTIONAL CARDIOLOGY IN SWITZERLAND

JOURNAL OF INTERVENTIONAL CARDIOLOGY 1995年第1期8卷 43-49页

作者： KAUFMANN, U MEIER, B UniversityHospital BernSwitzerland.

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Combination of minimally invasive coronary bypass and percutaneous transluminal coronary angioplasty in the treatment of double-vessel coronary disease:: Two-year follow-up of a new hybrid procedure compared with "on-pump" double bypass grafting

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AMERICAN HEART JOURNAL 2001年第4期142卷 563-570页

作者： de Cannière, D Jansens, JL Goldschmidt-Clermont, P Barvais, L Decroly, P Stoupel, E Erasme Univ Hosp Dept Cardiac Surg B-1070 Brussels Belgium Erasme Univ Hosp Dept Anesthesiol B-1070 Brussels Belgium Erasme Univ Hosp Dept Invas Cardiol B-1070 Brussels Belgium Duke Univ Hosp Div Cardiol Durham NC USA

Objective Percutaneous transluminal coronary angioplasty (PTCA) or surgery can be chosen as first-line therapies in multiple-vessel coronary disease. A mammary-to-left anterior descending (LAD) graft is the most important statistical determinant of a favorable outcome after coronary artery bypass grafting (CABG) and can be performed with lower morbidity off pump through a minithoracotomy. PTCA and stenting of the "non-LAD" vessels compete with CABG in terms of patency rates. Our purpose was to compare a combination of minimally invasive direct coronary artery bypass (MIDCAB) and PTCA with double CABG as a treatment for double-vessel coronary artery disease involving the proximal LAD. Methods Two matched groups of 20 patients with double-vessel coronary disease undergoing either sequential MIDCAB and PTCA (group 1) or double CABG on cardiopulmonary bypass (group 2) were compared. Angiographic control, complications, hospital costs, quality of life, and 2-year follow-up of ischemia are reported. Results All bypasses were patent at early control. Three adverse events were noted in group 1 and 17 in group 2. The hybrid-procedure group exhibited a shorter intensive care unit stay, fewer blood products transfused, less pain, better early quality of life, faster return to work, and similar cost. Three patients required a second PTCA in group 1, one of which For restenosis. At 2 years all the patients are asymptomatic with no residual ischemia. Conclusions We conclude from this pilot study that the hybrid procedure is feasible and appears to be a safe therapy for double-vessel coronary artery disease and that it appears to generate less perioperative morbidity than classic double CABG does. Therefore we believe that there is room to undertake prospective randomized studies on a larger-scale basis.

关键词：血管成形术经腔经皮冠状动脉/方法心肺转流术综合疗法冠状血管造影术/统计学和数值数据冠状动脉分流术/方法冠心病/诊断冠心病/外科学冠心病/治疗随访研究移植物闭塞血管/诊断移植物闭塞血管/流行病学健康状况胸廓内动脉-冠状动脉吻合术/方法疼痛测定试点项目生活质量问卷调查治疗结果老年人女(雌)性人类男(雄)性中年人

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Racial differences in the significance of coronary calcium in asymptomatic black and white subjects with coronary risk factors

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 787-794页

作者： Doherty, TM Tang, WY Detrano, RC Univ Calif Los Angeles Los Angeles Cty Harbor Med Ctr Dept Med Div Cardiol Torrance CA 90502 USA St Johns Cardiovasc Res Ctr Torrance CA USA

OBJECTIVES To compare the significance of a specific feature of coronary atherosclerosis - coronary calcium-in asymptomatic black and white subjects with coronary risk factors. BACKGROUND The natural history and clinical evolution of coronary atherosclerosis differs between blacks and whites. Differences in the underlying pathobiology of atherosclerosis may be one determinant of the ethnic variability in the clinical manifestation of coronary atherosclerosis. METHODS In 1,375 high-risk but asymptomatic subjects (93 blacks [6.8%] and 1,282 whites [93.2%]) with at least one risk factor but no prior evidence of coronary disease, we assessed coronary risk factors, calculated Framingham risk of a coronary event and evaluated coronary calcium with digital subtraction fluoroscopy. We then followed these subjects clinically for 70 +/- 13 months, noting the occurrence of the following coronary events: death due to coronary heart disease (CHD);myocardial infarction (MI);angina pectoris;and performance of coronary bypass or angioplasty. RESULTS Risk factor profiles were similar in black and white subjects (6-year Framingham risk 15 +/- 7% in blacks, 14 +/- 8% in whites [NS]). Coronary calcium was present in 59.9% of white subjects but only 35.5% of black subjects (p = 0.0001). Nevertheless, after 70 months of follow-up, more blacks than whites (22 blacks [23.7%] vs. 190 whites [14.8%];p = 0.04) suffered one of the following end points: CHD death, MI, angina or revascularization The age, gender and coronary risk-adjusted odds ratio of black race for at least one event was 2.16 (95% CI 1.34 to 3.48). CONCLUSIONS Despite having a lowered prevalence of coronary calcium than high risk whites, high risk blacks suffer more CHD events. Coronary calcium therefore does not carry the same pathobiologic significance in blacks that it does in whites, consistent with the concept that there are specific racial differences in the natural history of CHD and its evolution into clinically manife

关键词：非洲大陆世系人群钙质沉着症/诊断显像钙质沉着症/人种学队列研究冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠心病/人种学欧洲大陆世系人群 X线透视检查/方法 X线透视检查/统计学和数值数据随访研究预后前瞻性研究危险因素减影技术老年人女(雌)性人类男(雄)性中年人

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One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 707-715页

作者： Abizaid, AS Mintz, GS Abizaid, A Mehran, R Lansky, AJ Pichard, AD Satler, LF Wu, HS Kent, KM Leon, MB Washington Hosp Ctr Coronary Ultrasound Program Intravasc Ultrasound Imaging & Cardiac Catheteriz Washington DC 20010 USA

OBJECTIVES The purpose of this study was to correlate angiographic and intravascular ultrasound (IVUS) findings in left main coronary artery (LMCA) disease and identify the predictors of coronary events at one year in patients with LMCA stenoses. BACKGROUND Significant (greater than or equal to 50% diameter stenosis [DS]) LMCA disease has a poor long-term prognosis. METHODS One hundred twenty-two patients who underwent angiographic and IVUS assessment of the severity of LMCA disease and who did not have subsequent catheter or surgical intervention were followed for one year. Standard clinical, angiographic and IVUS parameters were collected. RESULTS The quantitative coronary angiography (QCA) reference diameter (3.91 +/- 0.76 mm, mean +/- +/- SD) correlated moderately with IVUS (4.25 +/- 0.78 mm, r = 0.492, p = 0.0001). The lesion site minimum lumen diameter (MLD) (2.26 +/- 0.82 mm) by QCA correlated less well with IWS (2.8 +/- 0.82 mm, r = 0.364, p = 0.0005). The QCA DS measured 42 +/- 16%. During the follow-up period, 4 patients died, none had a myocardial infarction, 3 underwent catheter-based LMCA intervention and 11 underwent bypass surgery. Univariate predictors of events (p < 0.05) were diabetes, presence of another lesion whether treated with catheter-based intervention or untreated with DS > 50% and IWS reference plaque burden and lesion lumen area, maximum lumen diameter, MLD, plaque area and area stenosis. Using logistic regression analysis diabetes mellitus, an untreated vessel (with a DS > 50%) and IVUS MLD were independent predictors of cardiac events. CONCLUSIONS In selected patients assessed byIWS, moderate LMCA disease had a one-year event rate of only 14%. Intravascular ultrasound MLD was the most important quantitative predictor of cardiac events. For any given MLD, the event sate was exaggerated in the presence of diabetes or another untreated lesion (>50% DS). (J Am Coll Cardiol 1999;34:707-15) (C) 1999 by the American College of Cardiology.

关键词：冠状血管造影术/仪器和设备冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠状血管/诊断显像随访研究 Logistic模型多元分析预后时间因素超声检查介入性/仪器和设备超声检查介入性/方法超声检查介入性/统计学和数值数据成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Transesophageal echocardiography in patients with ischemic stroke accurately detects significant coronary artery stenosis and often changes management

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AMERICAN HEART JOURNAL 2001年第5期142卷 916-922页

作者： Voros, S Nanda, NC Samal, AK Gomez, CR Liu, MW Puri, VK Jindal, A Terry, JB Tulyapronchote, R Thakur, AC Univ Alabama Heart Stn SW S102 Div Cardiovasc Dis Birmingham AL 35249 USA Univ Alabama Dept Neurol Birmingham AL 35249 USA

Objectives TEE is performed in many patients with ischemic stroke, and it is possible to examine the proximal coronaries by TEE in these patients. Our purpose was to (1) determine the accuracy of transesophageal echocardiography (TEE) in the diagnosis of proximal coronary stenosis in patients with ischemic stroke and (2) show that TEE detection of proximal coronary stenosis changed management in a substantial number of patients. Methods Thirty-two patients with ischemic stroke undergoing TEE, in whom the proximal coronaries were examined and who had angiographic results available, were studied. Results Proximal coronaries were visualized as follows: left main (LM) in 31 (97%), left anterior descending (LAD) in 32 (100%), left circumflex (LCx) in 30 (94%) and right coronary artery (RCA) in 21 (66%). The sensitivity and specificity of TEE in diagnosing significant coronary stenosis in visualized vessels were as follows: LM 100% and 100%, LAD 100% and 95%, LCx 100% and 96%, and RCA 100% and 100%, respectively. When visualized and nonvisualized segments were considered, TEE detected significant stenosis as follows: 4 of 5 in the LM (80%), 13 of 13 in the LAD (100%), 2 of 3 in the LCx (66%), and 2 of 8 in the RCA (25%). Of the 32 patients, TEE results changed management in 17 patients (53%). Angiographic findings resulted in 10 of the 17 patients (59%) undergoing revascularization. Conclusions TEE was very accurate in diagnosing significant coexisting coronary artery disease in patients with ischemic stroke. TEE diagnosis of these lesions prompted coronary angiography and subsequent revascularization in a substantial number of patients.

关键词：脑缺血/诊断脑缺血/流行病学脑缺血/放射摄影术共病现象冠状血管造影术/统计学和数值数据冠状动脉狭窄/诊断冠状动脉狭窄/流行病学冠状动脉狭窄/外科学超声心动描记术经食管/方法超声心动描记术经食管/统计学和数值数据心肌血管重建术敏感性与特异性成年人老年人女(雌)性人类男(雄)性中年人

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Prognostic significance of coronary artery calcium in asymptomatic subjects with usual cardiovascular risk

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AMERICAN HEART JOURNAL 2003年第3期145卷 542-548页

作者： Alexopoulos, D Toulgaridis, T Davlouros, P Christodoulou, J Sitafidis, G Hahalis, G Vagenakis, AG Univ Patras Sch Med Div Cardiol Dept Med GR-26110 Patras Greece

Background Coronary calcium detected noninvasively is an attractive way to diagnose atherosclerosis before the development of symptoms. This study examines the prognostic value of coronary calcium in asymptomatic subjects with usual cardiovascular risk. Methods and Results In 425 asymptomatic subjects, 229 men,(aged 45.1 +/- 14 years) and 196 women (aged 42.7 +/- 13 years), coronary calcium presence was studied by digital cinefluoroscopy. The majority (76 %) had no or at most one risk factor. Subjects were followed up for 58.4 +/- 12.7 months for cardiac events. Coronary calcium was present in 76 of 425 (17.9%) subjects. Cardiac events were observed in 21 subjects: 2 cardiac deaths, 7 acute (myocardial infarctions, 3 coronary artery bypass grafts, 3 coronary angioplasty procedures, 3, events of unstable angina, and 10 events of stable angina pectoris. Survival curve analysis showed significant differences in all the studied end points between subjects with and those without calcium. Coronary calcium was an independent predictor of all events (3.6-fold increase, P < .008), cardiac death/myocardial infarction/revascularization (13.9-fold increase, P < .02), and stable angina (7.4-fold increase, P < .007). However, calcium did not independently predict cardiac death/myocardial infarction or acute coronary syndromes. Conclusions Coronary calcium in asymptomatic subjects with usual cardiovascular risk adds significant incremental information to risk factors information for the development of symptomatic coronary artery disease.

关键词：钙质沉着症/放射摄影术电影X线摄影术/统计学和数值数据队列研究冠状血管造影术/统计学和数值数据冠状动脉分流术/统计学和数值数据随访研究心肌梗死/流行病学心肌梗死/死亡率预后危险性评估危险因素存活率分析女(雌)性人类男(雄)性中年人

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Stented segment length as an independent predictor of restenosis

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 651-659页

作者： Kobayashi, Y De Gregorio, J Kobayashi, N Akiyama, T Reimers, B Finci, L Di Mario, C Colombo, A Ctr Cuore Columbus I-20145 Milan Italy

OBJECTIVES We sought to evaluate the relation between stented segment length and restenosis. BACKGROUND Multiple or long coronary stents are now being implanted in long lesions or in tandem lesions. A longer stented segment might result in a higher probability of restenosis. However, there is little information available on the relation between stented segment length and restenosis. METHODS Between April 1995 and December 1996, 725 patients with 1,090 lesions underwent stenting. Lesions were divided into three groups according to the length of the stented segment: 1) group I (n = 565): stented segment length less than or equal to 20 mm;2) group II (n = 278): stented segment length >20 but less than or equal to 35 mm;and 3) group III (n = 247): stented segment length >35 mm. RESULTS There was no significant difference in the incidence of subacute stent thrombosis among the three groups (0.4% in group I, 0.4% in group II, 1.2% in group III;p = NS). The minimal lumen diameter (MLD) after stenting was greater in group I than in group III (3.04 +/- 0.60 mm in group I, 3.01 +/- 0.54 mm in group II, 2.91 +/- 0.58 mm in group III;p < 0.05). At follow up, a smaller MLD was observed in group III as compared with group I and group II (2.04 +/- 0.93 mm in group I, 1.92 +/- 1.00 mm in group II, 1.47 +/- 0.97 mm in group III;p < 0.01). The restenosis rates were 23.9% in group I, 34.6% in group II and 47.2% in group III (p < 0.01). Using multivariate analysis, the longer stented segment, the angiographic reference vessel diameter and the percent diameter stenosis after stenting were independent predictors of restenosis. CONCLUSIONS The present study shows that a longer stented segment is an independent predictor of restenosis without an influence on the risk of subacute thrombosis. (J Am Coll Cardiol 1999;34:651-9) (C) 1999 by the American College of Cardiology.

关键词：血管成形术气囊冠状动脉/仪器和设备血管成形术气囊冠状动脉/方法血管成形术气囊冠状动脉/统计学和数值数据卡方分布冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠心病/治疗冠状血管/诊断显像预后复发支架/统计学和数值数据超声检查介入性/方法超声检查介入性/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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Independent and incremental value of coronary artery calcium for predicting the extent of angiographic coronary artery disease - Comparison with cardiac risk factors and radionuclide perfusion imaging

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期34卷 777-786页

作者： Schmermund, A Denktas, AE Rumberger, JA Christian, TF Sheedy, PF Bailey, KR Schwartz, RS Mayo Clin & Mayo Fdn Div Cardiovasc Dis & Internal Med Rochester MN 55905 USA Mayo Clin & Mayo Fdn Biostat Sect Rochester MN 55905 USA Univ Texas Sch Med Dept Internal Med Div Cardiol Houston TX USA

OBJECTIVES The study was done to test the ability to predict the extent of angiographically determined coronary artery disease (CAD) by quantification of coronary calcium using electron-beam computed tomography (EBCT) and to compare it with more conventional parameters for delineating the angiographic extent of CAD, that is, cardiovascular risk factors and radionuclide single-photon emission computed tomography (SPECT). BACKGROUND The angiographic extent of CAD is a powerful predictor of subsequent events. Use of EBCT may be able to define it by virtue of its ability to determine plaque burden. METHODS We examined 308 patients presenting with suspected but not previously known CAD who underwent selective coronary angiography. As measures of the angiographic extent of CAD, coronary artery greater even 20 (CAGE greater than or equal to 20) and CAGE greater than or equal to 50 scores represented the total number of coronary segments with greater than or equal to 20% or greater than or equal to 50% stenoses, respectively. The EBCT derived total calcium scores were obtained in 291 patients, risk factors as defined by the National Cholesterol Education Program in 239 patients, and SPECT scans in 136 patients. RESULTS Using multiple linear regression analysis, total calcium scores were better independent predictors of both CAGE greater than or equal to 20 and CAGE greater than or equal to 50 scores than either a SPECT-derived radionuclide perfusion score or the risk factors age, male gender and ratio of total/high density lipoprotein (HDL) cholesterol. The association between EBCT and angiographic scores remained highly significant after excluding the influence of all interrelated risk factors and SPECT variables (r = 0.65;p < 0.001 for CAGE greater than or equal to 20 scores, r = 0.50;p < 0.001 for CAGE greater than or equal to 50 scores). CONCLUSIONS Coronary calcium predicts the angiographic extent of CAD in symptomatic patients and provides independent and incremental

关键词：钙质沉着症/诊断显像冠状血管造影术/方法冠状血管造影术/统计学和数值数据冠心病/诊断显像冠状血管/诊断显像运动试验/方法运动试验/统计学和数值数据线性模型预后放射性药物危险因素 99m锝甲氧基异丁基异腈铊放射性同位素体层摄影术发射型计算机单光子/方法体层摄影术发射型计算机单光子/统计学和数值数据体层摄影术 X线计算机/方法体层摄影术 X线计算机/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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ST-segment elevation on Q leads at rest and during exercise:: Relation with myocardial viability and left ventricular remodeling within the first 6 months after infarction

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AMERICAN HEART JOURNAL 1999年第6期137卷 1107-1115页

作者： Bodi, V Sanchis, J Llàcer, A Insa, L Chorro, FJ López-Merino, V Marins Baixa Hosp Cardiol Unit La Vila Joiosa Spain Univ Clin Hosp Dept Cardiol Valencia Spain

Background Resting ST-segment elevation on Q leads after an acute myocardial infarction has been related to a greater infarct size. Otherwise, the relation between exercise-induced ST-segment elevation and myocardial viability is controversial. We investigated the relation between ST-segment elevation on Q leads at rest and during exercise and regional dysfunction and its evolution, contractile reserve, left ventricular dilation, and coronary patency. Methods and Results Exercise testing and cardiac catheterization were performed at the first week after infarction in 51 patients. The study group was divided according to the existence (in 2 or more Q leads;n = 36) or not (n = 15) of resting ST-segment elevation and according to the existence (n = 28) or not (n = 23) of exercise-induced ST-segment elevation. Left ventricular end-diastolic and end-systolic volumes (mL/m(2)), regional wall motion (SD/chord), contractile reserve (wall motion percentage improvement with low-dose dobutamine), and coronary potency in the culprit artery were analyzed. Cardiac catheterization was repeated at the sixth month in 35 patients;systolic recovery (wall motion percentage improvement), left ventricular volumes, and coronary patency were again evaluated. Patients with resting ST-segment elevation showed poorer wall motion (2.1 +/- 0.8 SD/chord vs 1.2 +/- 1 SD/chord, P = .002), lesser contractile reserve (17% [0% to 39%] vs 41% [4% to 92%], P = .04), greater end-systolic volume (32 +/- 15 mL/m(2) vs 23 +/- 11 mL/m(2), P = .04), and higher percentage of occlusion (36% vs 7%, P = .04) than did patients without ST-segment elevation. likewise, patients with exercise-induced ST-segment elevation showed lesser contractile reserve (8% [0% to 40%] vs 35% [12% to 86%], P = .03) than did patients without exercise-induced ST-segment elevation. The only independent predictors of contractile reserve were wall motion <2 SD/chord (odds ratio [OR] 7.1, confidence interval [CI] 6.3 to 7.9, P = .01) and

关键词：方差分析冠状血管造影术/方法冠状血管造影术/统计学和数值数据心电描记术/统计学和数值数据运动试验/方法运动试验/统计学和数值数据心脏导管插入术/方法 Logistic模型心肌梗死/诊断心肌梗死/病理生理学心肌/病理学统计学非参数时间因素组织存活心室重构老年人女(雌)性人类男(雄)性中年人

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Utilization of coronary angiography and revascularization after acute myocardial infarction in men and women risk stratified by the American College of Cardiology/American Heart Association guidelines

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期35卷 974-979页

作者： Kilaru, PK Kelly, RF Calvin, JE Parrillo, JE Cook Cty Hosp Div Cardiol Chicago IL 60612 USA Rush Presbyterian St Lukes Med Ctr Cardiol Sect Chicago IL 60612 USA

OBJECTIVES We sought to determine whether men and women are equally likely to receive coronary angiography and revascularization after acute myocardial infarction (AMI) when they are risk stratified according to American College of Cardiology/American Heart Association (ACC/ AHA) practice guidelines for post-MI care. BACKGROUND Several previous studies have suggested that women may undergo angiography and revascularization procedures less frequently than men. METHODS In 439 consecutive patients admitted to a public hospital with AMI, rates of coronary angiography and revascularization were compared in men and women categorized, according to ACC/AHA. practice guidelines, as having strong (class I or IIa) or weaker (class IIb) indications for angiography. RESULTS Women were older and more likely to be diabetic or hypertensive, but men and women were equally likely to meet class Ima criteria for post-MI angiography (both 51%). Angiography rates were nearly identical in men and women overall (63% vs. 64%), as well as in patients in class I/IIa (80% vs. 82%) and class IIb (46% vs. 46%) (all p > 0.80, with >80% power to detect important differences);the only multivariate predictors of post-MI angiography were age and ACC/AHA class. Significant coronary artery disease was equally prevalent in men and women undergoing angiography, and men and women were equally likely to undergo revascularization, whether they were In class I/IIa (both 55%, p = 0.90) or class IIb (59% vs. 58%, p = 0.88). No significant differences in mortality were noted between men and women. CONCLUSIONS Despite being older and having more risk factors than men, women were equally likely to undergo coronary angiography and revascularization procedures after AMI, and they had in-hospital clinical outcomes that were at least as favorable. (C) 2000 by the American College of Cardiology.

关键词：年龄因素冠状血管造影术/统计学和数值数据心肌梗死/诊断显像心肌梗死/流行病学心肌梗死/治疗心肌血管重建术/统计学和数值数据诊疗准则(主题) 危险因素性别因素治疗结果美国/流行病学成年人老年人女(雌)性人类男(雄)性中年人

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