Objective To observe the effects of antiplatelet drugs on the incidence of no reflow,main adverse cardiovascular and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD).Methods From January 2010 to February 2011,a total of 84 CHD patients with no-reflow after PCI were selected and randomly divided into observed group and control group (n=42 each group).Patients with no/slow-reflow in observed group were injected with tirofiban through coronary artery with a guiding catheter.If invalid,patients were injected with tirofiban by catheterization again with a micro-pump continuous pumping for 24 h.Patients with no/slow reflow in control group were injected with verapamil by catheterization.If invalid,patients were injected with verapamil by catheterization again.Results The numbers of patients with Thrombolysis in Myocardial Infarction (TIMI) 3 in the first and last angiography after drug administration were much more in observed group than in control group [26 cases (61.9％) vs.17 cases (40.5％),35 cases (83.3％) vs.23 cases (54.8％),respectively,x2 =3.86,8.02,both P＜0.05].The first TIMI frame count (TFC) after drug administration was significantly lower in observed group than in control group,and the difference between groups became larger in the last TFC (t=-3.44,-12.41,both P＜0.05).The number of patients with TIMI myocardial perfusion grade (TMPG) 3 in the first and last angiography after drug administration were much more in observed group than in control group [24 cases (57.1％) vs.13 cases (31.0％),31 cases (73.8％) vs.20 cases (47.6％),respectively,x2=5.84,6.04,both P＜0.05].After 60 days of follow up,there was a significant difference in the incidence of endpoint events between observed and control group [23.8％ (10 cases) vs.52.3％ (12 cases),x2 =7.27.P＜0.01].The predisposing factors of no reflow were age,acute myocardial infarction (AMI),diabetes,hyperlipidemia and hypertension.Conclusions Tirofiban can effectively and safely reduce the incidence of no-reflow after percutaneous coronary intervention in patients with CHD.

Objective To analyze the clinical effect and complication of trans-radial and femoral artery for percutaneous coronary intervention (PCI) in patients with coronary heart disease.Methods Totally 153 patients with coronary heart disease undergoing PCI were divided into radial artery and femoral artery groups.X-ray exposure time,operation time,the success rates of puncture and operation,in-bed time and complication were recorded. Results There were no significant differences in X-ray exposure time[(17±5)min vs.(16±6)min,t=0.61,P=0.57],operation time [(49± 9) min vs. (48 ± 11) min,t=0.59,P =0.61],the success rates of puncture (98.7％ vs.100.0％,x2 =0.47,P=0.53) and operation (96.0％ vs.96.2％,x2 =0.14,P=0.64) between radial artery and femoral artery groups.However,the complication rates was higher in femoral artery group than in radial artery group (17.9％ vs.2.7 ％,x2 =9.54,P=0.002),in-bed time was shorter in radial artery group than in femoral artery group [(4.5 ± 1.2)h vs.(13.2 ±4.6)h,t=2.12,P =0.003]. Conclusions The trans-radial artery PCI is safe,effective and feasible,with less complications and shorter in-bed time.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.