ObjectiveTo investigate the impact of clopidogrel resistance on the long-term prognosis in the elderly with acute coronary syndrome (ACS), as clopidogrel is widely used for secondary prevention in the patients with ACS, while studies on the relationship between clopidogrel resistance and long-term outcome in the elderly with ACS are limited. MethodsThree hundred elderly patients with ACS, aged from 70 to 95, with on average age of (81.3±6.4) years old, receiving clopidogrel (75 mg, once a day) over one month between January 2009 and December 2010 were followed up for major adverse cardiac events (MACE, including cardiac death, non-fatal re-myocardial infarction, angina, ischemia stroke/TIA, acute thrombosis and hemorrhage). Platelet aggregation was measured by light transmission aggregometry using adenosine diphosphate as a stimulus. According to the variation of platelet aggregation, the patients were divided into clopidogrel resistance group (<10%) and non-lopidogrel resistance group (≥10%). The median follow-up was 2 years. A Cox hazard proportional model was used to estimate time to outcome associated with clopidogrel resistance and MACE. ResultsThe incidence of clopidogrel resistance was 24.0% in our study population. Patients with diabetes, renal insufficiency, or a higher body mass index tended to have clopidogrel resistance. Compared with those patients without clopidogrel resistance, there was significantly increased MACE in patients with clopidogrel resistance (37.5%, 22.8%; P=0.032). Additionally, Cox hazard proportional model analysis demonstrated that clopidogrel resistance was an independently risk factor for MACE[HR=2.34, 95% CI (1.07, 4.57), P=0.016]. ConclusionDiabetes, renal insufficiency and high body max index are associated with clopidogrel resistance, which can predict the increased risk of MACE in elderly patients with ACS.
In July 2023, six scientific organizations, including the American Heart Association (AHA) and the American College of Cardiology (ACC), jointly released the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease. By reviewing the latest scientific data, the guideline reemphasized the importance of a healthy diet, regular physical activity and smoking cessation in cardiovascular health. Routine testing is limited to patients with changes in clinical or functional status. Regarding the clinical management of CCD, the guideline limited the use of beta-blockers (BB) and updated recommendations for the usage of three drugs, including sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 (GLP-1) receptor agonists, and bempedoic acid.
摘要:目的: 研究尿微量白蛋白與冠心病的相關性。 方法 : 按冠狀動脈造影診斷標準將116例患者分為冠心病組(82人) 與非冠心病組(34人),測定晨尿白蛋白/ 肌酐濃度值(ACR),比較兩組患者尿ACR 并分析ACR與冠脈病變程度的相關性。 結果 : 冠心病組ACR顯著高于非冠心病組的; ACR與冠脈計分呈顯著的直線正相關。 結論 :冠心病患者ACR水平升高,微量白蛋白尿與冠狀動脈病變范圍和程度密切相關, 且對冠狀動脈狹窄程度具有獨立預測價值。Abstract: Objective: To investigate the relationship between microalbuminuria and coronary artery disease(CAD). Methods : According to the diagnostic standard of coronary artery angiography,116 patients were divided into CAD group (82 patients) and nonCAD group (34 patients). The albumin and creatinine concentrationratio ratio(ACR) in morning urine samples from patients of both groups was estimated and compared. The correlation of ACR to the extent of coronary lesions was analyzed. Results : ACR in the CAD group was significantly higher than that in nonCAD group. A distinctly linear positive correlation existed between ACR and the score of the coronary lesions. Conclusion : ACR increase in patients with CHD.Micoalbuminuria was associated with the severity of coronary lesions in patients with CHD and is an independent predictor of CAD.
Objective To summarize experience in surgery about off-pump coronary artery bypass grafting(OPCAB)for the treatment of left main with three-vessel coronary disease. Methods OPCAB were perfomed in 33 patients of left main with three-vessel coronary disease. The left internal mammary artery(LIMA) was used to be the graft vessel to anastomose with left anterior descending. The saphenous vein was used to be the graft vessel to anastomose with left circumflex coronary artery, right coronary artery/posterior descend artery, diagonal branch, obtuse marginal branch. Results There was no operative death.The average number of grafting was 3.4 per case.There was no perioperative myocardial infarction, respiratory or hepatic or renal failure and other serious complications.Blood transfusion was not needed in 33% of cases.The angina pectoris was free after operation in all cases. Conclusions OPCAB is safe and effective for the treatment of left main with three-vessel coronary disease. The injuries were minimal. Preoperative preparation, using of intra-aortic balloon counterpulsation, operative matching, techniques and to create a skill and swift team for meet an emergency are the key factors to assure surgical outcome.