Objective To investigate the impact of hs-CRP and IVUS on major adverse cardiac event in patients who after coronary artery intermediate lesions stent implantation.Methods 82 patients with clinical diagnosis of coronary heart disease who had a segmental stenosis degree is 40％ ～ 70％ in one major coronary artery on coronary angiography,all of the patients do intravascular ultrasound,patients had minimal lumen area(MLA) of intermediate lesions ≤ 4mm2( the left main coronary artery)or≤ 6mm2( left main coronary artery) who received percutaneous coronary intervention(PCI),and the patients were divided into 2 groups,hs-CRP rise group(≥3mg/L) and hs-CRP normal group(＜3mg/L),compared the rate between the two groups in hospital and follow up periods by typical angina,nonfatal myocardial infarction,cardiac death and target-vessel revascularization and other major adverse cardiac events (MACE).Results The rate on major adverse cardiac event in hs-CRP rise group was significantly higher than the normal group(P ＜0.01 );the restenosis rate in hs-CRP rise group higher than hs-CRP normal group(P ＜0.01 ).Conclusion hs-CRP could predict the rate on major adverse cardiac event in patients with after coronary artery intermediate lesions stent implantation,the patients of hs-CRP rise group should strengthen antiplatelet,anti-inflammatory treatment etc.

Objective To summarize the clinical features,treatment and follow-up of patients with severe coronary artery spasm.Methods Twenty-one patients with confirmed coronary artery spasm were selected.The study reviewed the patients' general conditions including age,gender,complication,smoking and drug situations.The clinical features,electrocardiogram and coronary angiography data were analyzed.Their diagnosis,treatment and prognosis were evaluated.Results Male (86％,18/21) had higher incidence in severe coronary artery spasm.Smoking (62％,13/21) was a major risk factor.Coronary artery spasm often happened on the base of a fixed narrow (57％,12/21),and the clinical process was treacherous.Coronary angiography was very important for early diagnosis.Calcium antagonist was the core of the treatments and should be sustained at full dose.Interventional therapy was not efficacious.Although patients in acute phase had higher risk,long-term prognosis was good.Conclusions Coronary artery spasm is a common problem,but it is often overlooked.Timely diagnosis is the key to prevent fatal events.Calcium antagonist is the core of the coronary artery spasm drugs.The long-term prognosis of coronary artery spasm is good.

Objective To evaluate PICCO (pulse indicator continuous cardiac output) to predict fluid responsiveness in patients with acute lung injury secondary to septic shock.Methods We conducted a prospective study on 42 patients with acute lung injury secondary to septic shock.global end-diastolic volume index (GEDVI),pulse pressure variation (PPV),stroke volume variation (SVV),central vein pressure (CVP) and other haemodynamic data were recorded before and after fluid administration of 500 mL of 6％ hydroxyethyl starch.Responders were defined as patients with an increase in stroke volume index of at least 15％ after fluid loading.Performance of variables was analyzed using receiver operator characteristics analysis.Results GEDVI and PPV,but not SVV and CVP,were able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 1 hrs after admission to intensive care unit (ICU).The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.802,P ＜0.01) and PPV (AUC 0.752,P ＜0.01) ; the optimal cut-off of GEDVI and PPV were 643.5 mL/m2 and 13.5％,respectively.At this cut point,the sensitivity was 90.9％,the specificity was 91.9％,however,only GEDVI was able to predict fluid responsiveness in patients with acute lung injury secondary to septic shock 6hrs afteradmission to ICU.The best area under the ROC curve (AUC) was found for GEDVI (AUC 0.788,P ＜ 0.01).the GEDVI ＜ 559 mL/m2 during loading were found to predict volume responsiveness with a sensitivity of 100％,specificity of 62.5％.Conclusions GEDVI and PPV predict fluid responsiveness in patients with acute lung injury secondary to septic shock in the early hours.

Objective To observe the correlation between non-high density lipoprotein cholesterol levels and coronary artery disease(CAD),extent of angiographic coronary artery lesions and risk factors of CAD.Methods Serum total cholesterol ( TC ),triglyceride ( TG),high density lipoprotein cholesterol ( HDL-C ),low density lipoprotein (LDL-C),Lp(a),apoA-1 and apo B levels were measured in 282 patients with angiographic CAD meanwhile in 129 normal controls without angiographic coronary artery lesions.Non-HDL-C and LDL-C/HDL ratio was calculated.Logistic regression and partial correlation were used to find the correlation of serum non-HDL-C with CAD.Results Non-HDL-C[ (3.40 ± 1.01 ) mmol/L vs (3.08 ±0.65)mmol/L,P ＜0.05],LDL-C[ (2.63 ±0.84) mmo/L vs (2.40 ±0.54) mmol/L,P ＜0.05 ],TC[ (4.48 ± 1.07)mmol/L vs (4.23 ±0.69) mmol/L,P ＜0.05 ],and LDL-C/HDL ratio [ ( 2.52 ± 0.96) vs (2.21 ± 0.74 ),P ＜ 0.05 ] were significantly higher in the CAD group than in the control group.The four indexes also showed an increasing trend in the sequence of single,double and triple vessel lesions.Multivariate Logistic regression analysis found that among lipid factors,only non-HDL-C was independently associated with CAD.The results of partial correlation analysis demonstrated that non-HDL-C was positively correlated to the number of lesions( r =0.250,P ＜0.01 )and gensini score of CAD( r =0.116,P ＜0.05 ).Conclusion Non-HDL-C level is an independent risk factor for CAD and significantly correlated with the severity of CAD.

Objective To investigate the correlation between the prognosis and the early lactate clearance in patients with postcardiac surgery undergoing cardiopulmonary bypass.Methods The clinical data of 73 patients who underwent postcardiotomy undergoing cardiopulmonary bypass in SuBei Hospital of Jiangsu Provience,from March 2006 to February 2010,were prospectively collected and analyzed.The collection data including:( 1 ) Preoperative factors:including gender,age,diagnosis preoperative,NYHA grade,APACHE Ⅱ score and left ventricular end-diastolic diameter.(2) Operative factors:operation time,block aorta time.(3)Postoperation factors:hemorrhage volume,mechanical ventilation time,and factors of hemodynamics and oxygen metabolism at 6 hour postoperative:heart rate(HR),central venous pressure(CVP),pulmonary capilary wedged pressure( PCWP),cardiac output index( CI),arterial blood lactic acid,6 h lactate clearance,partial pressure of oxygen( PO2 ),mixed venous oxygen saturation ( SvO2 ),oxygen delivery index ( DO2I),oxygen consume index (VO2I),oxygen extraction ratio(O2ext).Patients were divided into survival group,control group,high level of lactate clearance group( lactate clearance rate ＞ 30％ ) and low level of lactate clearance group.Firstly,the data analyzed with process of single variable analysis and some parameters,which showed the significant difference,were sorted out from two groups.Then these parameters were put to the Logistic regression analysis.Consequently,the independent risk factors of death of postcardiac surgery could be found.Results The mortality in high lactate clearance group ( 4.55％ [ 2/44 ] ) was significantly less than the low lactate group (34.48％ [ 10/29] ) ( x2 =11.889,P ＜0.01 ).The single variable analysis had shown that there were significant difference on APACHE Ⅱ score ( [ 16.9 ± 2.9 ] vs [ 19.2 ± 2.6 ],t =2.537 ),left ventricular end-diastolic diameter( [ 53.9 ± 5.6 ] mm vs [ 63.8 ± 4.6 ] mm,t =5.847 ),block aorta time ( [ 101.2 ± 34.2 ] min vs [ 122.7 ±22.7 ] min,t =2.078 ),hemorrhage volume( [464.0 ± 158.8 ] ml vs [ 603.2 ± 159.5 ] ml,t =2.773 ),mechanical ventilation time( [ 22.6 ± 5.1 ] h vs [ 28.8 ± 5.2 ] h,t =3.857 ),arterial blood lactic acid ( [ 3.5 ±1.3 ] mmol/L vs [5.1 ± 1.5 ] mmol/L,t =3.912),lactate clearance ( [38.8 ± 17.4]％ vs [ 14.6 ±9.7]％,t =4.846),and SvO2( [69.1 ±4.2]％ vs [59.2 ±6.9]％,t =5.847) (P＜0.05 or P ＜0.001)between survival group and control group.Multiple regression analysis showed that lactate clearance and left ventricular enddiastolic diameter were the two independent risk factors of death,and the odds ratio(OR) were 7.773 (95％ CI 1.364-44.306,P ＜0.05) and 15.186(95％ CI 2.758-83.162,P ＜0.01).Conclusion Early lactate clearance rate can be used as an important indicator to evaluate the prognosis of patients with postcardiac surgery undergoing cardiopulmonary bypass.

ObjectiveTo evaluate the safety and efficacy of firofiban in gerontal patients with acute coronary syndrome(ACS). MethodA total of 106 elderly patients with ACS admitted form December 2006 to June 2008 were enrolled in a prospective case-control study. Patients were divided into percutaneous coronary intervention (PCI) group and medicine group. Both groups were randomly divided into two sub-groups, tirofiban sub-group and placebo sub-group. Patients in the PCI group received tirofiban infused in dose of 10 μg·kg- within 3 minutes as loading dose before operation and then an infusion of 0.15μg'kg-1·min-1 as maintenance dose for 24～36 hours. In medicine group,the loading dose was 0.4 μg·kg-1·min-1×30 min and the maintaining dose was 0.1 μg·kg-1·min-1×48 hours, The rates of major adverse cardiac events (MACE) consisting of death, myocardial infarction or refractory ischemia during hospital stay stay and 30 days' follow-up, bleeding rates TIMI grade, corrected TIMI frame count (CTFC) and myocardial blush grade(MBG) after PCI were compared between sub-groups of PCI group. ResultsThe basic clinical data were similar among the sub-groups. In medicine group,the MACE rate during 30 days' follow-up was much lower in the tirofiban sub-group than in the placebo sub-group (12.0% vs. 36.4 %, P < 0.05). In comparison with medicine group, in PCI group, there were fewer TIMI frames [(23.5 ±5.1) frames vs. (31.4±5.2) frames, P < 0.01] and higher percentage of myocardial blush grade 3(64.3% vs. 29.0%, P < 0.01) in firotiban sub-group of PCI group. No significant differences in bleeding rates were found between all sub-groups. ConclusionsTirofiban is safe and effective in gerontal ACS patients with blood flow and reperfusion improved.

Objective To discuss the clinical effects and the major adverse cardiac events of intracoronary prostaglandin E1 injection prior to percutaneous coronary intervention (PCI) in early(within 24h of symptom onset) interventional treatment for patients with acute non -ST segment elevation myocardial infarction ( NSTEMI ) . Methods 122 patients with NSTEMI who underwent early interventional treatment were divided into three groups according to the digital table:41 cases in prostaglandin E 1 group,41 cases in nitroglycerin group ,40 cases in control group.The TIMI blood flow was compared among the three groups after PCI .All patients were followed up during 6 months about major adverse cardiac events ( MACE) and the cardiac structure and function by echocardiography . Results After primary PCI,the corrected TIMI frame count(CTFC) was significantly better in the prostaglandin E 1 group[(20.22 ±6.82)] than in the nitroglycerin group[(26.35 ±8.71)] and the control group[(27.02 ±9.65), t=6.451,6.763,all P<0.05].The TIMI myocardial perfusion grade (TMP) was significantly better in the prosta-glandin E1 group(7.3％) than in the nitroglycerin group(26.8％) and the control group(30.0％)(P<0.05). There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).All patients were followed up for 6 months,the LVDd in the prostaglandin E1 group[(46.8 ±3.7)mm] was significantly lower than that in the nitroglycerin group[(49.5 ±5.8) mm] and the control group [(50.2 ±4.9) mm,t=6.312, 5.893,all P<0.05].The LVEF in the prostaglandin E1 group [(55.8 ±8.2)％] was significantly higher than that in the nitroglycerin group [(49.3 ±7.9)％] and the control group [(50.5 ±6.8)％,t=7.011,5.981,all P<0.05].The incidence rate of MACE in the prostaglandin E 1 group(4.9％) was significantly lower than that in the nitroglycerin group(12.2％) and control group(12.5％)(χ2 =5.834,5.719,all P<0.05).There was no statistically significant difference between the nitroglycerin group and the control group (P>0.05).Conclusion Intracoronary administration of prostaglandin E 1 injection prior to balloon dilation can significantly improve the myocardial microcir-culation perfusion,and can decrease MACE in patients with NSTEMI who underwent early interventional treatment .

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.

Objective To explore the clinical efficacy of prostaglandin E1 injected by coronary or peripheral venous in early stage (within 24 h of symptom onset) in treating patients with acute non-ST segment elevation myocardial infarction (NSTEMI) by percutaneous coronary intervention (PCI) and its influence on major adverse cardiac events (MACE).Methods A total of 136 patients with NSTEMI underwent PCI within 24 h were divided into intracoronary injection group,peripheral vein injection group and control group.All the patients were followed up for 9 months,no reflow or slow blood flow,the incidence of angina pectoris,heart failure,and target vessel revascularization,recurrent myocardial infarction and cardiac death and major cardiac adverse events during hospitalization were compared between three groups.The changes of left ventricular end diastolic diameter (LVDd),left ventricular ejection fraction (LVEF) and other indicators were compared.Results After PCI,the corrected TIMI frame count (CTFC) and TIMI myocardial perfusion grade (TMP) were significantly better in intracoronary injection group than peripheral vein injection group and control group (P ＜ 0.05).All patients were followed up for 9 months,LVDd in intracoronary injection group was significantly lower than those in peripheral vein injection group and control group (P ＜ 0.05).LVEF in intracoronary injection group was significantly higher than that in peripheral vein injection group and control group (P ＜ 0.05).The incidence rate of MACE in intracoronary injection group was significantly less than that in peripheral vein injection group and control group (P ＜ 0.05).There was no significantly difference between the peripheral vein injection group and control group (P ＞ 0.05).Conclusion For NSTEMI patients with early PCI,intracoronary injection and peripheral intravenous injection of prostaglandin E1 can get a better myocardial microcirculation reperfusion during operation,and intracoronary injection can significantly reduce the incidence of adverse cardiac events.

Objective To summarize the experience of applying transradial sheathless technique in treat-ment of bifurcation coronary lesions. Methods The clinical data on 39 patients with bifurcation coronary lesions who received transradial PCI using sheathless guide catheter produced by ASAHI or self-made sheathless guide catheter were retrospectively analyzed. Passing ability of sheathless guide catheter, success rate and complications of PCI were observed.Results There were 10 patients with left main bifurcation lesions, 29 left anterior descend-ing branch and diagonal branch bifurcation lesions. 33 patients were treated using sheathless of 7.5 Fr and 6 were treated by self-made sheathless guide catheter.PCI achieved expected goal.No catheter placement related complica-tions, cardiovascular or cerebrovascular events were observed in 39 patients in their hospital stay. Conclusions Transradial sheathless technique can be applied in of coronary lesions. Sheathless of 7.5 Fr is easy to use and has perfect passing ability.Sheathless guide catheter is effective,safe and highly practicable.Both procedures are worth of clinical application.