Objective?To explore the glucometabolic state of angiographically documented inpatients with coronary artery disease (CAD) but without diagnosed diabetes mellitus (DM). Methods?The study recruited 449 patients, who were performed a coronary angiography as well as an oral glucose tolerance test (OGTT) when admitted in the cardiovascular medical ward in our hospital from January 2007 to May 2009. According to the results of coronary angiography, the patients were divided into a coronary artery disease (CAD) group and a non-coronary artery disease (non-CAD) group, and abnormal glucose metabolism (AGM) status was compared between the two groups. Results?The random plasma glucose (RPG) and fasting plasma glucose (FPG) had no significant differences (P values were 0.249 and 0.444, respectively) in the two groups, while the OGTT 2-hour plasma glucose (2hPG) was much higher in the CAD group, with a significant difference (Plt;0.001) compared with the non-CAD group. The CAD group had a prevalence of AGM up to 74.0%, of which 32.1% were newly diagnosed DM patients, and 39.0% were impaired glucose tolerance (IGT) patients, much higher than that in the non-CAD group, respectively, there being a significant difference (P=0.006). Logistic regression analyses revealed that the risk of IGT and newly diagnosed DM was 1.6 times (OR=1.603, 95% CI 1.023 to 2.512, P=0.04) and 2.3 times (OR=2.292, 95% CI 1.391 to 3.777, P=0.001) as much as that in non-CAD patients, respectively; when adjusted for the factors such as hypertension, dyslipidemia, BMI, hs-CRP, and other factors, CAD patients still had a higher risk of newly diagnosed DM (OR=1.852, 95%CI 1.064 to 3.223, P=0.029), compared with the non-CAD patients. Conclusion?AGM is common in the admitted patients with CAD but undiagnosed diabetes, most of whom need an OGTT to be diagnosed timely and accurately. OGTT should be considered to be a routine inspection item to diagnose AGM in the inpatients with CAD; if possible, all hospitalized patients with cardiovascular disease should be performed an OGTT routinely.
【摘要】目的 探讨胸部X线片检查发现的主动脉弓钙化与冠心病的不同临床表现类型的相关性。方法 回顾分析2006年7月-2008年2月期间经冠状动脉造影证实的冠心病患者的临床资料,对比分析胸部平片所见的主动脉弓钙化情况与冠心病不同临床类型的相互关系。结果 116例经冠状动脉造影证实的冠心病患者纳入研究。其中,稳定型心绞痛40例,急性冠脉综合征76例(不稳定型心绞痛21例、非ST段抬高心肌梗死38例、ST段抬高心肌梗死17例)。40例稳定型心绞痛患者中,有主动脉弓钙化者21例,占52.5%;76例急性冠脉综合征患者中,有主动脉弓钙化者22例,占28.9%。与急性冠脉综合征相比,更多的稳定型心绞痛患者合并有主动脉弓钙化(χ2=6232,P=0013)。结论 在不同的冠心病临床类型,主动脉弓钙化更易在稳定型心绞痛患者中发现。【Abstract】 Objective To investigate the relationships between calcification of aortic arch and different clinical classification of coronary artery disease. Methods The clinical data of patients with coronary artery diease who diagnosed by arteriography from July 2006 to February 2008, were retrospectively analyzed. The Xray data on calcification of aortic arch and clinical characteristics of patients with coronary artery disease confirmed by coronary angiography were analyzed. The relationship between coronary calcification of aortic arch which showed by Xray and different clinical classification of coronary artery disease were comparatively analyzed. Results Among the total of 116 patients, 40 stable angina and 76 acute coronary syndrome were included, and 21 (52.5%) and 22 (28.9%) patients with calcification of aortic arch were observed respectively. In comparison to patients with acute coronary syndrome, more stable angina patients were complicated with calcification of aortic arch (χ2 =6232,P=0013). Conclusion It is more likely to document calcification of aortic arch in patients with stable angina.
Objective To summarize the outcomes and clinical features for surgical treatment of nonischemic heart valve disease(HVD) combined with coronary artery disease(CAD), so that to get better surgical result. Methods From January 2000 to June 2007, 105 patients with the mean age of 61.96±7.61 years (range 36-79 years), underwent the combined procedures.The etiology of HVD included: 59 rheumatic valve disease, 24 degenerative mitral lesion, 13 calcified aortic valve lesion, and 9 other aortic valve disease. CAD was preoperatively diagnosed by coronary arteriongraphy in 98 patients, and intraoperatively identified in 7 patients. Left ventricular ejection fraction was 50% or less in 45 patients. The total number of bypass grafts was 216 with the mean of 2.06 grafts per patient. Valve procedures included: 36 mitral valve valve replacement, 15 mitral repair,43 aortic valve replacement, 11 mitral valve and aortic valve replacement. Results There were 6 postoperative deaths with the mortality of 5.7%. The causes of death were 3 low cardiac output syndrome, 2 renal failure, and 1 heart arrest resulting in multiple organs failure. Ninety-three survivals were followed up from 1 month to 7 years, 6 patients were missed on follow-up. There were no late death. New York Heart Association class Ⅰ was observed in 25 patients, class Ⅱ53, class Ⅲ 10 and class Ⅳ 5. One patient still had existential chest pain. Conclusion There were no typical angina in majority of patients with nonischemic HVD combined with CAD, coronary arteriongraphy must be taken in patients with the age of 50 years and more, or with the risk factors for CAD.Intraoperative myocardial protection is very important because CAD further deteriorates myocardial dysfunction caused by HVD.The decreased left ventricular function is the important factor affecting the surgical results and it is hard to evaluate the underlying cause before the operation.
Abstract： Objective?To summarize our experience of redo coronary artery bypass grafting（CABG） and explore appropriate redo CABG strategy for Chinese patients. Methods We retrospectively analyzed clinical data of 27 patients who underwent redo CABG in People’s Hospital of Peking University from January 2000 to January 2010. There were 15 male patients and 12 female patients with their age of 41-84 （63±8） years. The mean time between the first CABG and the redo CABG was 45 （4-168） months. Preoperatively all the patients had unstable angina pectoris. Twenty-one patients were in New York Heart Association （NYHA） functional classⅠ-Ⅱ， and 6 patients were in NYHA functional classⅢ-Ⅳ. Preoperatively， their left ventricular end-diastolic dimension （LVEDD） was 41-69 （51.0±0.7） mm， and their left ventricular ejection fraction （LVEF） was 32%-78% （58%±12%）. At the time of redo CABG for the 27 patients， there were 6 new coronary artery lesions， 7 left internal mammary artery （LIMA） lesions， 3 radial artery lesions （including 1 proximal anastomosis lesion alone） and 49 saphenous vein graft （SVG） lesions （including 3 proximal lesions alone and 3 distal lesions alone）.?Results?The surgical approach of redo CABG included median sternotomy in 18 patients， left lateral thoracotomy in 8 patients， upper midline abdomen and subxiphoid incision in 1 patient. Off-pump coronary artery bypass grafting （OPCAB） surgery was performed in 25 patients， but intra-operatively 2 patients underwent conversion to CABG under cardiopulmonary bypass. A total of 65 distal anastomoses and 41 proximal anastomoses were performed during redo CABG. A total of 10 LIMA， 3 right internal mammary artery (RIMA)， 16 left radial artery， 2 right radial artery and 17 SVG were used in redo CABG . There were 1-4 （2.4±0.8） distal anastomoses for each patients. The operation time was 170-530 （304±86）min. Postoperative transfusion was 0-10 （4.3±3.5） U packed red blood cells and 0-1 600 (685±549) ml fresh frozen plasma for each patient. Postoperative mechanical ventilation time was 6-156 （24±32） h and postoperative hospital stay was 7-35 （14±6） d . There was no in-hospital death. All the patients were discharged without any angina symptoms. A total of 26 patients were followed up and 1 patient was lost with the mean follow-up time of 80 （13-133） months. During follow-up， 16 patients were alive without angina symptoms， 4 patients died， and 6 patients had recurrent angina symptoms or heart failure. Conclusions OPCAB is an effective surgical strategy of redo CABG， but cardiopulmonary bypass should also be prepared. Arterial graft should be use as long as possible in redo CABG and the surgical strategy should be individualized.
Objective To investigate the relationship between diabetic retinopathy (DR) and coronary atherosclerosis (CAS) in type 2 diabetes patients and other risk factors of DR. Methods A total of 118 patients of type 2 diabetes with DR (DR group), 120 patients of type 2 diabetes without DR matched in age and sex (non-DR group), and 86 normal controls (control group) were enrolled in this study. The body mass index (BMI), blood pressure (BP), fasting blood-glucose (FPG), glycosylated haemoglobin (HbA1C), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterin (LDL-C), creatinine, estimate glomerular filtration rate (eGFR) and urinary albumin excretion rate(UAER) in all the subjects were measured. Meanwhile, the incidence of CAS in the three groups was detected by 64slice multidetector computed tomography angiography (MDCTA). Assume concurrent DR as dependent variable, clinical indicators and laboratory parameters as independent variable, the risk factors were determined by Logistic regression analysis. In addition, CAS as dependent variable, DR as fixed factor, analysis of covariance was used to investigate the relationship between CAS and DR. Results The incidence of CAS in DR group was higher than that in nonDR group and control group, the differences were statistically significant (chi;2=26.9,35.5;P＜0.05). The results of Logistic regression analysis showed that systolic BP, BMI, CAS, myocardial infarction and UAER were key risk factors for DR ［odds ratio (OR)=1.02, 0.89, 4.50, 3.89, 1.34;P＜0.05］. There was a negative relationship between BMI and DR. The results of analysis of covariance showed that there was significant correlation between CAS and DR (OR=5.31, 95% confidence interval=2.62-10.60; P＜0.05). Conclusion CAS is independently associated with DR in type 2 diabetes patients. In addition, the other risk factors for DR include systolic BP, BMI, myocardial infarction and UAER.
Objective To summarize the early outcomes and clinic al experience of off-pump coronary artery bypass grafting (off-pump CABG) afte r off-pump coronary endarterectomy (CE) for patients with diffused coronary art ery disease. Methods From May 2003 to November 2006，83 patients with diffu sed coronary artery disease underwent CE without cardiopulmonary bypass and off-pump CABG. There were 61 males and 22 females with age ranged from 55 to 80 ye ars (65±7 years). There were 7 patients in Canadian Cardiac Society(CCS) an gina classⅡ,20 patients in class Ⅲ,and 56 patients in class Ⅳ. 36(43.4%) pat ients had history of myocardial infarction. Coronary angiogram revealed th at 5 patients had double vessels disease, and other 78 patients had triple ves s els disease with 16 left main stem disease. The left ventricular ejection fract ion(LVEF) ranged from 25% to 65% (51%±16%). One hundred and ten endarter e ctomies were performed in 83 patients totally which included 67 in left anterior descending artery(LAD)，9 in circumflex artery and 34 in right coronary artery . Twenty patients received onlay venous patch after CE in LAD and then grafte d by internal mammary artery (IMA) on the patch. There were 83 left IMA, 2 radia l arteries, others were great saphenous veins, the mean number of grafts was 3.9 ±1.2. Results There was no death in all patients. Intraoper ative graft flowmeter was used to check the flow in the grafts before chest cl osure. One hundred and one (92%) out of 110 grafts after CE showed a satisfactor y grafts flow(22±16ml/min) intraoperatively. Four patients had perioperative myocardial infarctions but none had hemodynamic changes. All patients discharged uneventfully. Seventyfive patients (90.4%) had 8 to 50 months followup with no angi na reoccurrence. Eight patients had coronary angiogram from 3 to 29 months af ter operation with all patent grafts to the CE coronaries. Conclusion Off-pump CABG with coronary endarterectomy is feasible and achieves surgical revascularization in patients with diffuse cor onary artery disease.
Objective To evaluate the efficacy and safety of drug-eluting stents in treating patients with coronary artery disease compared with bare metal stents. Methods MEDLINE, EMBASE, CBMdisc and other databases of clinical trials were searched for meta-analysis and randomized controlled trials (RCTs) both in Chinese and English language. Conference abstracts, personal reference lists, reference lists of retrieved studies and some websites were also searched. Statistical analysis was performed using RevMan 4.2 software. Results Meta-analysis was performed on the results of 25 RCTs with 5 different drug-eluting stents. Seven trials evaluated efficacy and safety of sirolimus-eluting stent, the results of meta-analysis indicated that SES decreased rates in stent restenosis compared with bare metal stent, and therefore the target lesion revascularization and adverse cardiac event rates, no “catch up” were found. Eight trials compared a paclitaxel-eluting stent with bare metal stent, similar results were found, i.e. decreased stent restenosis rate, target lesion revascularization and adverse cardiac event rates in patients receiving paclitaxel-eluting stent compared with bare metal stent. Three trials compared CYPHERTM and TAXUS stents head to head, and the combined analysis showed a superiority of CYPHERTM to TAXUS. But available data can not draw a conclusion with regard to the effect of drug-eluting stents on mortality, occurrence of MI or stent thrombosis. Everolimus-eluting stent had the same performance as these two drug-eluting stents above, but because of a small sample size, no further conclusion can be made. Actinomycin D eluting stents and 7-hexanoyltaxol-eluting stents increased restenosis rate and stent thrombosis rate respectively. Poor performance limited further clinical trials of these two stents. Conclusions Sirolimus-eluting stent and polymetric paclitaxel-eluting stent are efficient and safe in patients with coronary artery atherosclerosis. Sirolimus eluting stent CYPHERTM seems better than paclitaxel eluting stent TAXUS.
Objective To study the characteristics of endothelin(ET) and hemodynamics parameters in patients with coronary artery disease (CAD) in perioperative period and aim to find out some rules and useful suggestions for clinical trial. Methods Fortyseven patients were divided into 5 groups: patients undergoing coronary artery bypass grafting (CABG) and resection of left ventricular aneurysm(CABG+LVAN group),patients undergoing classical CABG(CABG group), patients undergoing offpump coronary artery bypass grafting (OPCAB group), patients undergoing transmyocardial laser revascularization (TMLR group), and group control, patients undergoing mitral valve replacement because of rheumatic heart disease(RHD). The ET was measured in the following time: before operation, before aortic clamping(or before revascularization or before TMLR), aortic declamping(or just after revascularization or just TMLR), 3 h, 6 h, 24 h after reperfusion. CI was measured before operation, 3 h, 6 h and 24 h after reperfusion, respectively. Results ET Compared in each group: in CABG+LVAN group, it significantly increased when aortic declamping (69.93±7.20 pg/ml),at 3 h (89.99±5.76 pg/ml),6 h (60.94±8.69 pg/ml) and, 24 h (6899±10.30 pg/ml) after reperfusion than that beforeoperation (40.17±13.37 pg/ml，Plt;0.05); in CABG group, ET significantly increased when reperfusion(66.59±4.86 pg/ml), at 3 h (95.97±10.72 pg/ml), 6 h (61.51±765 pg/ml) and, 24 h (57.85±6.34 pg/ml) after reperfusion than that beforeoperation(43.22±9.13 pg/ml，Plt;0.05); in OPCAB group, ET increased significantly when reperfusion(66.47±5.90 pg/ml) than that beforeoperation(44.80±6.51 pg/ml，Plt;0.05), and then returned to normal level; in TMLR group,there is no difference before and after operation; in control group, ET increased significantly after operation. ET compared between different groups: ET level was higher in CABG group than that in OPCAB group at 3 h after reperfusion(95.97±10.72 pg/ml vs.59.72±4.81 pg/ml,Plt;0.05). Although CI significantly increased after myocardial reperfusion in all groups, the CI was significantly higher in OPCAB group than that in CABG group at 3 h after reperfusion(3.25±0.05 pg/ml vs. 2.17±0.46 L/min·m2,Plt;0.05). Conclusions In patients with CAD, the ET increases after operation, but the increasing levels are different among the different groups. In patients with OPCAB, the changes of ET and hemodynamics are mild, and heart function recovers quickly, so OPCAB is a very good choice for CAD surgical therapy if the indications are suitable; In patients with classical CABG, the changes of ET are obvious, and the heart function recovers a little bit slowly, but they all can return to normal level at 24 h after operation; TMLR is a good supplement for CAD therapy.
Objective To compare the clinical effects of coronary artery bypass grafting (CABG) via the left anterior small thoracotomy (LAST) versus lower-end sternal splitting (LESS) approach in the treatment of coronary heart disease. Methods The patients who underwent LAST CABG in Tianjin Chest Hospital from October 2015 to December 2020 were allocated to an observation group (LAST group), and the patients who underwent LESS CABG at the same period were allocated to a LESS group. Propensity score matching method was applied with a ratio of 1∶1. The baseline data, perioperative data and grafts data were compared between the two groups after matching. Results Before matching, there were 110 patients in the LAST group, and 206 patients in the LESS group. After matching, there were 110 patients in each group. In the LAST group, there were 83 males and 27 females with an average age of 60.6±8.3 years. In the LESS group, there were 80 males and 30 females with an average age of 61.0±9.6 years. There was no statistical difference in baseline data between the two groups after matching (P>0.05). The hospital stay time (t=2.255, P=0.025) and ventilator using time (t=−2.229, P=0.027) in the LAST group were significantly shorter than those in the LESS group. There were no statistical differences between the two groups in the postoperative hospital stay time, ICU stay time, postoperative left ventricular ejection fraction, postoperative left ventricular end-diastolic diameter, average number of grafts, secondary intubation, secondary thoracotomy, postoperative wound infection, sternal complications, postoperative atrial fibrillation, postoperative pulmonary infection or main adverse cardiovascular and cerebrovascular events (P>0.05). There was no statistical difference in the distribution of target vessels in the anterior descending branch, diagonal branch or posterior descending branch between the two groups (P>0.05). The grafts of the LAST group were significantly more than those of the LESS group in the area of obtuse marginal branch and posterior ventricular branch, and the grafts of the LESS group were significantly more than those of the LAST group in the area of right coronary artery (P<0.05). Postoperative computerized tomography angiography indicated that 1 patient in the LAST group had obtuse marginal branch vein bridge vessel occlusion, and the bridge vessels in the other patients were unobstructed. Conclusion Minimally invasive CABG via both LAST and LESS approaches is safe and effective. LAST approach can achieve complete revascularization for multi-vessel lesions, and it is safe and reliable, with the advantages of less trauma and aesthetic appearance. However, it requires a certain learning curve of surgical techniques and certain surgical indications.
Objective To investigate the treatment and prognosis of moderate ischemic mitral regurgitation (IMR) in coronary artery disease(CAD). Methods From January 1998 to May 2006, 28 patients of CAD with moderate IMR underwent coronary artery bypass grafting (CABG) and mitral valve plasty(MVP, 24) or mitral valve replacement (MVR,4). The Reed method were used in 9 cases, the annuloplasty ring were used in 15 cases. Mechanical valve were implanted in 1 case and biological valve in 3 cases. Results There was no operative or hospital death. Twentysix patients were followed up to a mean period of 41 months. There were two late death(one was MVP, the other was MVR). In MVP cases, nineteen patients were in New York Heart Association (NYHA) functional class Ⅰ and Ⅱ, 3 in class Ⅲ, which was better than that of preoperative one. Ultrasonic cardiography (UCG) examination showed no mitral regurgitation in 5 cases, mild in 7, light in 6, moderate in 3, severe in 1. Left atrial volume (LAV) and left ventricular enddiastolic volume (LVEDV) were 54.1±12.7ml and 60.9±14.8 ml, decreased more significantly than that preoperatively (Plt;0.05). In MVR cases, 2 cases were survival and followed. One patient was in NYHA functional class Ⅰ, 1 in class Ⅱ, which was better than that of preoperative one. Conclusion Moderate IMR with CAD should be treated carefully. MVP with annuloplasty ring have better early results. For patients with bad heart function and abnormal left ventricular wall motion, the late results need more studies.