Objective To investigate the efficacy and safety of warfarin in the prevention of cerebral infarction in nonvalvular atrial fibrillation (NVAF). Methods One hundred and thirty-six NVAF patients were randomized into warfarin group [receiving adjusted-dose warfarin,international normalized ratio(INR)was 2.0 - 3.0], aspirin group( receiving aspirin 100 mg/d) and control group (treated without anticoagulants )by random digits table. Followed up 18 months, and the main end point events and adverse effect of the three groups were compared. Results In 136 cases,4 cases lost,and 77 cases(58.3%) were male. The mean dose of warfarin was(2.5 ± 1.0) mg. During the follow-up period, main end point events occurred in 12 cases,with 1 case (2.50%, 1/40) in warfarin group, 4 cases(9.52%, 4/42 ) in aspirin group and 7 cases ( 14.00%, 7/50)in control group. There was no significant difference in main end point events among the three groups ( x2 =2.084,P =0.353). But in the patients with 3 or above risk factors,there was significant difference in the survival curve among the three groups ( x2 = 6.404, P = 0.041 ). The incidence rate of bleeding was higher in warfarin group than that in aspirin group,but there was no significant difference [5.00%(2/40) vs. 2.38%(1/42),P ＞ 0.05]. Conclusions Warfarin can improve survival rate especially in the patients with 3 or above risk factors,and the complication of bleeding occurs mostly when INR ＞ 3.0.Under closed monitoring (INR 2.0-3.0),adjusted-dose warfarin is safety and efficacy.

ObjectiveTo investigate the effect of intensive dose atorvastatin on preventive contrast-induced nephropathy (CIN) in elder with coronary heart disease (CHD) after elective percutaneous coronary intervention (PCI).Methods110 subjects older than 60 who received elective PCI,were randomly divided into intensive dose atorvastatin group (the study group,n =50) and conventional treatment group (the control group,n =50).On the ba sis of the hydration therapy,the study group received atorvastatin and the control group received atorvastatin.Scr、β2- MG and liver function were checked for evidence of tubular or glomemlar damage before and after elective PCI were compared between the two groups.Ccr was calculated according to Cockcroft-Gault formula;The incidence of the major adverse cardiovascular events (MACE) and cytotoxicity and hepatotoxicity of rosuvastation were respectively recorded in 30 days follow-up period.ResultsCcr in the study group was significantly higher than that in the control group at day 1 [( 73.12 ± 16.89 ) ml/min vs ( 63.89 ± 18.42 ) ml/min,P =0.036],day 2 [( 65.32 ± 13.46 ) ml/min vs (55.63 ± 15.47 )mL/min,P =0.021] ;Blood β2-M in the study group was significantly lower than that in the control group at day 1 [( 2.44 ± 0.42 ) ml/min vs ( 2.69 ± 0.63 ) mL/min,P =0.009],day 3 ( 2.52 ± 0.46 ) mL/min vs (2.81 ±0.63) ml/min,P =0.011],day 3[(2.37 ±0.43) ml/min vs (2.54 ±0.65 ) ml/min,P =0.021].The incidence of CIN was lower in the study group than that in the control group(6％ vs 24％,P =0.012).During 30days clinical follow-up,the incidence of the MACE in the control group was more than the study group ( x2 =5.316,P =0.021).There was no significant difference between the two groups for the cytotoxicity and hepatotoxicity.ConclusionHigh dose atorvastatin may be more efficient in prevention CIN in elder before elective PCI and this higher dose may be safe to the elder.

Objective To investigate the risk factors of electrical storm(ES) in patients with acute myocardial infarction (AMI) during perioperative period of direct percutaneous coronary intervention(PCI).Methods Forty-one AMI patients had been treated with direct PCI.The patients with perioperative ES were included in ES group and those without perioperative ES were included in conntrol group.ES was defined as the occurrence of spontaneous ventricular tachycardia or venicular fibrillation was twice or more within 24 h and unable to stop by itself and emergency treatment was needed.The difference of the clinical data between two groups were compared.Results There were 7 in 41 patients with direct PCI who had ES,the incidence was 17.07％,and 34 cases didn't have ES.Systolic pressure,diastolic pressure,white cell count,blood glucose,international normalized ratio and time duration from chest pain onset to direct PCI between two groups had no significant differences (P ＞0.05).Age,CK-MB,cardiac troponin I,the diameter of infarctrelated arleries(IRA ),incidence of reperfusion arrhythmia and mortality of ES group were all obviously higher than those of control group (P ＜ 0.05 or ＜ 0.01 ).The incidence of ES in patients whose IRA was left main artery or occlusion of middle section of two main coronary arteries,right coronary artery,left anterior descending branch and left circumflex artery was 66.67％(2/3),18.75％(3/16),11.76％(2/17) and O, respectively.Conclusions Perioperative ES during direct PCI most commonly occurrs in AMI patients with left main artery or occlusion of middle section of two main coronary artery.The diameter of IRA,TIMI flow classification after the patency of IRA and recanalization arrhythmia are the main risk factors of the occurrence of perioperative ES.