Objective To evaluate the efficacy and safety of low-dose tirofiban combined with dual anti-platelet therapy in patients undergoing coronary stent implantation for acute coronary syndrome.Methods From October 2010 to July 2013,a total of 306 patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome were enrolled and divided into 2 groups:triple anti-platelet group (156 patients) and dual anti-platelet group (150 patients).Patients in triple anti-platelet group received low-dose tirofiban with starting dose 0.4 μ g/(kg· min) and 0.1 μ g/(kg·min) after 30 min for 24-36 h on the basis of dual anti-platelet therapy.Patients in dual anti-platelet group only received dual anti-platelet therapy.Information of the bleeding time,the clotting time,the platelet count change,the major adverse cardiac events (MACE),bleeding events in both groups were observed and the efficacy and safety were evaluated.Results The rate of thrombus of stent and target vessel revascularization were 2.0％ (3/150) and 2.7％ (4/150) in dual anti-platelet group,0.6％ (1/156) and 0.6％ (1/156) in triple anti-platelet group,and there were no significant differences between two groups (P ＞ 0.05).There was no significant difference in the rate of bleeding events between two groups (P ＞ 0.05).The bleeding time and clotting time in two groups were extended at different degree,but there were no significant differences (P ＞ 0.05).Conclusions Additional use of low-dose tirofiban is effective and safe in patients undergoing coronary stent implantation for acute coronary syndrome.It could not only reduce the MACE rate but also improve the coronary blood flow.Moreover,it does not increase the bleeding events.

Objective To analyze the characteristics of Han and Uygur patients with acute myocardial infarction (AMI)of coronary artery disease and its risk factors in Kashi area.Methods The clinical data of 98 cases of Han and Uygur 152 cases with AMI (including acute ST segment elevation myocardial infarction and acute non ST segment elevation myocardial infarction)were retrospectively analyzed.And risk factors were analyzed.Results Uygur patients with AMI in hypertension,diabetes,smoking,obesity and Han patients with no significant difference(P >0.05).In Uygur patients with AMI high density lipoprotein cholesterol(HDL -C)was (1.10 ±0.36)mmol/L,which was lower than Han patients (1.41 ±0.53)mmol/L(t =6.701,P <0.05),triglyceride(TG)[(2.21 ±1.40)mmol/L] higher than Han patients[(1.76 ±0.77)mmol/L](t =6.393,P <0.05),total cholesterol and low density lipoprotein cholesterol and Han patients compared with no significant difference(P >0.05).The level of fibrinogen(FIB)in Uygur AMI patients[(4.02 ±0.84)g/L]was higher than that in Han patients[(3.69 ±0.69)g/L](t =8.420,P =0.004).Uygur patients with acute myocardial infarction coronary angiography showed multiple lesions in the majority, the involvement of blood vessels in the anterior descending branch,there was no significant difference between the Han patients(P =0.713).No obvious abnormal vessels of Han and Uygur AMI patients in coronary angiography showed no statistically significant differences(P =0.003).Conclusion Uygur patients had more history of dyslipidemia,triglyceride and fibrinogen levels were higher than the Han nationality,low density lipoprotein levels were lower than that of the Han nationality.Patients with no obvious lesion in the coronary artery were less than the Han patients.

Objective To explore the value of peripheral blood sCD146 as a long-term survival ben-efit marker in elderly patients with acute ST segment elevation myocardial infarction(ASTEMI)after PCI.Methods A total of 210 patients who were diagnosed with ASTEMI and underwent PCI in our hospital from January 2021 to July 2022 were enrolled,and according to the postopera-tive sCD146 level,they were divided into low-,medium-and high-level groups(69,65 and 76 cases respectively).All of them were followed up,with endpoint events including all cause death,cardiac death,and major adverse cardiovascular events(MACE).Kaplan-Meier survival curve was plotted to compare the cumulative survival rate of each group,and COX regression analysis was used to analyze the relationship between peripheral blood sCD146 level and prognosis.Results The mor-tality rate and MACE incidence were significantly higher in the high-level group than the low-and medium-level groups(P＜0.05).Kaplan-Meier curve analysis showed that the high-level group had obviously lower cumulative survival rate than the other two groups(P＜0.05).COX regres-sion analysis revealed that the sCD146 level in peripheral blood after PCI was independently cor-related with the occurrence of death in ASTEMI patients after PCI(OR=1.530,95％CI:1.144-2.044,P=0.004).Conclusion The peripheral blood level of sCD146 is closely related to long-term survival benefits in ASTEMI patients after PCI,and sCD146 can be used as a biomarker to evaluate their long-term survival benefits.

Objective:To discuss the analysis on predictive factors of periprocedural myocardial inj ury (PMI)for type 2 diabetes patients with chronic total occlusion (CTO)from the pespective of clinical data,laboratory examination and imaging characteristics.Methods:Totally 134 cases with type II diabetes combined CTO in Zhongshan hospital of Fudan university heart intervention center database during January 2013 to December 2014 were selected.Results:In 134 cases with type 2 diabetes combined CTO,the average age was (62.12±9.018),in which male accounted for 81.34%(109/134).The incidence of PMI was 14.2% (19/134).Patients wre divided into PMI group (n= 19)and non-PMI group (n= 115)according to the occurrence of perioperative myocardial inj ury.The single factor analysis showed that the significant differences of ostial occlusion ,blunt stump,severe tortuosity,longer CTO length>20 mm,retrograde approach,Reverse CART approach,and J-CTO score between two groups.The Logistic multiple regression analysis showed that the Reverse CART approach (OR 7.580,P<0.05),occlusion length>20 mm (OR 3.642,P<0.05)were the independent predictor of PMI in type 2 diabetes patient with CTO.Conclusions:The Reverse CART technology,and occlusion length>20 mm are the independent predictor of PMI of type 2 diabetes mellitus combined CTO.To predict the special risk for perioperative myocardial injury patients, assessment of adverse cardiac events iscontributing to the choice of treatment strategy.

Chronic total occlusion(CTO)is the difficult point for percutaneous coronary intervention(PCI).Because of its special pathological basis,the patient's requirements are very high,the operation success rate is low,and the complication rate is high.Perioperative myocardial injury(PMI)is a complication of CTO-PCI.Compared with non-occlusive lesions,CTO-PCI can lead to PMI when it involves larger branch vessels and collateral vessels.This article reviews the causes,prevention and treatment progress of PMI associated with CTO-PCI.