| Part OneEvaluation of Coronary Artery Plague of Acute Coronary Syndrome by Multiple Detector Computed TomographyBackground As the development of computed tomography(CT) technology recently, especially the application of multiple detector computed tomography (MDCT), detection of the morphology characteristics of vulnerable plaque of coronary artery by non-invasive technology becomes possible. At present,64-slice CT coronography is one of the most advanced non-invasive method for evaluaion of coronary artery, with the advantages of non-invasiveness, accuracy, swiftness and visuality, which plays a very important role in diagnosis of low and middle-risk patients with coronary heart disease. However, there is insufficient research on that the measurement of CT value of the plaque by64-slice CT is used to evaluate components of the plaque and infer the nature of the plaque in order to indicate its stability. How to differentiate the unstable plaque of ACS by MDCT is the important problem that we need to solve.Objective The objective of the study is to analyze and evaluate the MDCT characteristics of infarction-related artery in ACS patients, and compare that with coronary angiography, in order to provide references for MDCT evaluation of vulnerable plaque in clinical practice.Methods fourty-five patients with ACS(including6with ST elevation myocardial infarction,14with non-ST elevation myocardial infarction and25with unstable angina pectoris), who were treated in the emergency department of our hospital and received MDCT examination from March2011to December2012. were included and the MDCT characteristics were analyzed, including the stenosis of the lumen and the plaque status around the stenosis, and compared with the results of coronary angiography. Meanwhile,42patients with stable angina pectoris (SAP)were selected as controls.Results The incidence of low-density plaques by MDCT coronography in ACS group was significantly higher than that in SAP group(57.6%vs13.8%, P<0.05); The number of culprit lesion vessels, in ACS group was higher than than that in SAP group (3.1±1.1VS.2.1±1.2, P<0.05).The culprit lesion was not different in ACS group and SAP group. Meanwhile, during MDCT examination for ACS, one patient (2.2%) was found to have pulmonary embolism. For ACS patients, MDCT can be used to understand the degree of stenosis of ischemia-related vessels and assist the risk stratification.Conclusion In the patients with acute coronary events, MDCT can specifically detect the stenosis of coronary artery, and meanwhile evaluate the status of vulnerable plaque, which is important for understanding of vulnerable plaque of coronary artery. MDCT can be used to understand the status ofocclusion, severe stenosis or patency of infarction-related artery in time, and guide the risk stratification for patients, so as to provide meaningful clinical information for the selection of further treatment; meanwhile, it is also helpful for screening of triad of chest pain (acute myocardial infarction, pulmonary embolism and aortic dissection). Part TwoCorrelation Analysis between MPO,MMP-3,9,hs-CRP andMDCT Evaluation of Vulnerable Plaque of Acute CoronarySyndromeBackground Atherosclerosis is a kind of progressive inflammatory artery disease,which is the major reason for cardiovascular diseases and also the major reason forpatient morbidity and mortality. Rupture of fibrous cap of unstable atheroscleroticplaque (vulnerable plaque,VP) and local thrombus formation is the main mechanismfor the occurrence and development of acute coronary syndrome (ACS). Becausebiochemical assays have the characteristics of rapidity and easy operation,there aregreat prospects of its clinical application for diagnosis and prediction of ACS.However,presently,there are insufficient systemic studies on the correlation betweeninflammatory bio markers and MDCT evaluation of ACS. So the correlation analysisbetween MPO. MMP-3,9hs-CRP and MDCT results of ACS were performed in thestudy.Objective The study is mainly to evaluate the relation between the inflammatoryfactors in the serum(MPO,HS-CRP and MMP-3,9) and MDCT results of ACS,andfurther demonstrate the clinical significance of those inflammatory factors in ACS.Methods The study subjects were divided into three groups,45patients with ACS,42patients with stable angina pectoris(SAP). and96controls with normal coronaryartery. The serum levels of MPO. hs-CRP and MMP-3,9were measured,and theserum level of MPO. MMP-3.9and HS-CRP ofthree above-mentioned groups atadmission were compared respectively. Meanwhile,in combination with the analysisresults of MDCT plaque,the correlation between inflammatory markers and MDCTvulnerable plaque were analyzed.Results In comparison with patients with SAP and normal controls,the serumlevel of MPO in ACS patients was higher (514.3±324.1vs.281.5±235.6,240.8±147.1,P<0.01),and the serum level of MMP-9and hs-CRP in ACS patients wassignificantly higher than that in patients with SAP and normal controls(MMP-9,1540.3±1259.vs.1261.7±551.4,354.9±193.6,P＜0.001,hs-CRP,4.8±5.2.vs.2.0±2.2.1.8±2.3,P<0.01)o the serum level of MMP-3was no significant different in threegroup(167.5±185.1vs.135.4±98.6,134.8±95.4,P>0.05). The serum levelsofMPO inACS were significantly higher than that in SAP and controls,The serum levels ofMMP-9in ACS and SAP group were both significantly higher than that in normalcontrols,but the serum levels of MMP-9were no significant different in ACS and SAP. The serum levels of MMP-3were no significant different in three group. The serum levels MPO,MMP-9, hs-CRP in ACS were related with coronary low density plaque, but no related with coronary stenosis by MDCT evaluation. meanwhile, it was also found that the serum level of MPO, MMP-9, hs-CRP and MDCT evaluation of ACS low density plaque were correlated,but the serum level of MMP-3was not related with plaque characteristic by MDCT evaluation.Conclusion The results of the study in the serum level of MPO, MMP-9, hs-CRP and MDCT evaluation demonstrate that inflammation factors is closely related with the incidence and development of ACS,and indirectly reflect the stability of plaques. The serum level of MPO, MMP-9, hs-CRP are correlated with MDCT evaluation of plaque characteristics,but MMP-3is not significantly related in this study. Part ThreeClinical outcomes of drug-eluting stents following rotational atherectomy via the transradial approach for the treatment of heavily calcified coronary lesionsObjective To assess the clinical outcomes of drug-eluting stents following intracoronary artery rotational atherectomy via the transradial approach for the treatment of heavily calcified coronary lesions.Methods From January2009to October2012,114consecutive patients with heavily calcified coronary lesions underwent rotational atherectomy and drug-eluting stents via transradial approach in our hospital were enrolled in this retrospective study. Characteristics of heavily calcified coronary lesions, the success rates of rotational atherectomy and stenting, rates of complication during perioperation treatments, and adverse cardiovascular events during hospitalization and follow up were analyzed.Results All114patients were successfully treated with rotational atherectomy and drug-eluting stent placement,and totally120target lesions were treated including8left main lesions,93left anterior descending and2circumflex,17right coronary lesions. No-reflow was observed in7patients during the procedure, there was one case of entrapped rotablator burr which was successfully retrieved together with guiding catheter without serious complication. During the6months (median) follow-up, angina was reported in11patients and revascularization was performed in8patients due to stent restenosis and intensified medical therapy was applied in3patients. There was no acute myocardial infarction and death during follow-up.Conclusion Drug-eluting stents following intracoronary artery rotational atherectomy via transradial approach is feasible, effective and safe and the short-term outcome is satisfactory for patients with heavily calcified coronary lesions. |
PDF Full Text Request