Drug-Eluting Stents ; Humans ; Percutaneous Coronary Intervention ; methods

Angioplasty, Balloon, Coronary ; Humans

Angioplasty, Balloon, Coronary ; Chronic Disease ; Coronary Occlusion ; therapy ; Humans

Humans ; Myocardial Infarction ; physiopathology ; therapy ; Myocardial Reperfusion

Adult ; Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary ; Emergency Treatment ; Female ; Humans ; Male ; Middle Aged ; Tachycardia ; therapy

Angioplasty, Balloon, Coronary ; Coronary Occlusion ; diagnostic imaging ; therapy ; Fluoroscopy ; adverse effects ; Humans ; Male ; Middle Aged ; Radiodermatitis ; etiology ; Treatment Failure

Antithrombotic therapy is the cornerstone of the treatment of coronary heart disease. To optimize antithrombotic therapy is one of ongoing efforts made by cardiovascular physicians. The randomized controlled clinical research of high quality in the field of antithrombotic therapy for coronary heart disease is still lacking in our country at present, and it become an important problem to be urgently solved in China. As there are studies with rich research data on antithrombotic therapy for cardiovascular disease domestically, and the differences in the problems involved between eastern and western populations, a preliminary exploration had been done in 2012 in the research center where the author is serving. This paper chiefly reviews the problems of major concern in antithrombotic therapy, our present situation, and treatment strategy based on our experience in clinical research for years.

Objective To explore the relationship between symptom-onset-to-balloon time and in-hospital mortality in patients with ST elevation myocardial infarction (STEMI). Methods Since October 2010, all cardiovascular intervention procedures in military hospitals were registered online, including coronary interventions. Data in this study were originated from this registry database. Primary endpoint was in-hospital mortality, and it was stratified by age and infarction location to explore the effects of these factors on the mortality rate. Results 8878 STEMI patients from 92 military medical centers were enrolled in this study. These patients were divided into 3 groups by the length of onset-to-vessel opening time: interval ≤3h (n=2999), interval between 3 and 6h (n=2369), and interval >6h (n=3510). The in-hospital mortality rate in those groups was 2.5%, 2.9% and 3.0%, respectively (P=0.405). In interval ≤3h group, mortality rate in young (<50 years) patients with non-anterior MI was 0.5%, while mortality rate in old (>70 years) patients with anterior MI was as high as 7.4% (P<0.001). ConclusionsIn-hospital mortality rate in STEMI patients is related to onset-to-vessel opening time. Patients with old age or anterior MI are a high-risk cohort.

Contrast-induced acute kidney injury (CIAKI), known as the most important complication after exposure to intravascular iodine based contrast agents, has attracted increasing attention with the development of cardiac intervention in recent years. CIAKI is harmful as it increases the risk of renal failure and death, prolongation of hospitalization time, and increase in expenditure. Moreover, lack of obvious clinical manifestation makes CIAKI more easily neglected by clinicians. Preceding risk assessment and giving prophylactic measures to high risk patients may lower the incidence of CIAKI. Continuous renal function monitoring after intervention procedure is helpful to detect CIAKI. Hydration has been proved to be effective for the prevention of CIAKI. However, the affect of other medication has not been well evaluated up to now. A multicenter, randomized and controlled study, performed in union in 53 domestic hospitals with the same protocol, demonstrated that short-term statin therapy during perioperative period of invasive cardiovascular procedure can effectively reduce the incidence of CIAKI. It may give us a new strategy to prevent CIAKI.