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简介：BackgroundInpatientswithacutecoronarysyndrome(ACS),loweradmissionsystolicbloodpressure(SBP)levelsinferaworseprognosis.However,thepredictivepotentialofadmissionSBPon1-yearmortalityhasnotfullyelucidatedinpatientswithnon-ST-segmentelevationACS(NSTEACS).MethodsWeenrolled1325patientstoinvestigatetheassociationbetweenadmissionSBPinpatientshospitalizedforNSTEACS.WeanalyzedtheassociationbetweenadmissionSBPand1-yearmortality.AdmissionSBPwascategorizedaslow(<110mmHg),normal(110-140mmHg),high(141-160mmHg),andveryhigh(>160mmHg).ResultsComparedwithpatientswithnormaladmissionSBP,thosewithlowSBPhadasignificantlyincreasedhazardratios(HRs)for1-yearmortalityof3.03(P<0.05),whilepatientswithhighandveryhighadmissionSBPhadnosignificantlyincreasedHRsfor1-yearmortality.ConclusionLowadmissionSBP,butnotelevatedadmissionSBP,isastrongindependentpredictorof1-yearmortalityinpatientswithNSTEACS.

简介：Furtherunderstandingofthepathphophisyology,advanceofthediagnosisinstrumentandrenovationoftheriskdelaminationstandardcanofferbettertherapyevidenceforthenon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS).Drugs,suchastrigeminyantiplateletdrug,prasugrel,fondaparinuxandbivalirudin,havebroughtgreatclinicaleffecttothehighriskpatients.SincetheresultoftheICTUStestannouncedandthedrugelutingballoondeveloped,wehavereachedthenewestrecognitionofhowtoselectachanceforinterventionandhowtopreventandcuretherestenosisofin-stent.

简介：BackgroundNon-ST-segmentelevationacutecoronarysyndrome(NSTE-ACS)isanacuteheartdiseasecausedbyincompleteocclusionofrelatedcoronaryarterieswithunstableatheroscleroticplaques.LeadaVRSTsegmentelevationandcTnIpositivearecloselycorrelatedtotheprognosisofNSTE-ACSpatients.However,therearefewstudiesapplyingthetwopredictorstoearlyriskstratificationinNSTE-ACSpatients.MethodTwohundredandfivecasesofNSTE-ACSpatientsfollowedupfor6monthsafterdischargewerereviewed.Allpatientsweredividedintofourgroups:GroupA-cTnInegativecombinedwithaVR-non-ST-segmentelevationgroup(100cases);GroupB-cTnInegativecombinedwithaVR-ST-segmentelevationgroup(31cases);GroupC-cTnIpositivecombinedwithaVR-non-ST-segmentelevationgroup(43cases);GroupD-cTnIpositivecombinedwithaVR-ST-segmentelevationgroup(31cases).Therewasnosignificantdifferenceingender,age,oldmyocardialinfarction,previousPCIhistory,hypertension,anddiabetesbetweenaVR-STelevationgroupandnoaVR-STelevationgroup.Themorbidityofleftmainorthree-vesselcoronaryarterydiseaseaswellasadversecardiovasculareventsinthefourgroupswereobservedandanalyzed.Results(i)Themorbidityofleftmainorthree-vesselcoronaryarterydiseasewashighestinGroupD(87.1%),andwasmarkedlyhigherinGroupB(41.9%)thanthatinGroupA(7%)orGroupC(9.3%);(ii)TheincidenceofadversecardiovasculareventswashighestinGroupD(77.4%),andwasmuchhigherinB(35.5%)ascomparedwiththattinGroupA(1%)orgroupC(7%).ConclusionElectrocardiographicleadaVRST-segmentelevationcombinedwithcTnIpositivehasanimportantclinicalvalueinpredictingtheprognosisofthepatientswithNSTE-ACS.

简介：Toanalyzetheclinicalcharacteristicsof216patientswithnon-STsegmentelevationmyocardialinfarction(NSTEMI).MethodsAretrospectiveanalysiswasused.TwohundredandsixteenNSTEMIpatientsweredividedintotwogroups:①accordingtotheage:age<65yearsgroupandage≥65yearsgroup;②accordingtothrombolysisinmyocardialischemiatrial(TIMI)IIBriskstratificationscoringsystem:score<4groupand≥4group;③accordingtoserumcreatinine(sCr)level:sCrlevel≤178μmol·L-1groupand>178μmol·L-1group.Sevenhundredandeightysixacutemyocardialinfarction(AMI)patientsduringthesameperiodweredividedintoSTsegmentelevationmyocardialinfarction(STEMI)groupandNSTEMIgroup.Clinicalcharacteristicsofthepatientsinthetwogroupswerecompared.Results①ThenumberofNSTEMIpatientsinage≥65yearsgroupissignificantlygreaterthanthatinage<65yearsgroup.Studyrevealedthatthepatientsinage≥65yearsgroupwerewithoutchestpain,hadhypertension,dyslipidemia,atrialfibrillation,cardiacandrenaldysfunction(sCr>178μmol·L-1)andtriplevesseldisease.Fewerpatientsinthisgroupreceivedcoronaryarteryangiography(CAG),percutaneouscoronaryintervention(PCI)andcoronaryarterybypassgraft(CABG).Morenumberofdeathsinthisgroupcomparedwiththeage<65yearsgroup.②ThenumberofNSTEMIpatientsinTIMIscore>4groupissignificantlygreaterthanthatinTIMIscore<4group.Fourmajorcomplicationssuchasacuteleftventricularfailure,cardiogenicshock,seriousarrhythmiaanddeaths,increasedsignificantlyinTIMIscore>4groupcomparingwithTIMIscore≤4group.③Obviously,morenumberofelderlypatients,non-insulindependantdiabetesmellitus(NIDDM),patientswithcardiactroponinT(CTnT)>3.0ng·L-1anddeathsoccurredinsCr>178μmol·L-1group.④STEMIandNSTEMIpatientswerecomparedinsametimeframeasfollows:fewerNSTEMIpatientsandmoreelderlypatientshadnochestpain,NIDDM,hypert

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简介：BackgroundThecombinationofglycoproteinⅡb/Ⅲainhibitorsandheparinhasnotbeencomparedwithbivalirudininstudiesspecificallyinvolvingpatientswithnon-ST-segmentelevationmyocardialinfarctionundergoingpercutaneouscoronaryintervention(PCI).Wecomparedthetwotreatmentsinthispatientpopulation.MethodsImmediatelybeforePCI,werandomlyassigned,inadouble-blindmanner,1721patientswithacutenon-ST-segmentelevationmyocardialinfarctiontoreceiveabciximabplusunfractionatedheparin(861patients)orbivalirudin(860patients).Thestudytestedthehypothesisthatabciximabandheparinwouldbesuperiortobivalirudinwithrespecttotheprimarycompositeendpointofdeath,largerecurrentmyocardialinfarction,urgenttarget-vesselrevascularization,ormajorbleedingwithin30days.Secondaryendpointsincludedthecompositeofdeath,anyrecurrentmyocardialinfarction,orurgenttarget-vesselrevascularization(efficacyendpoint)andmajorbleeding(safetyendpoint)within30days.ResultsTheprimaryendpointoccurredin10.9%ofthepatientsintheabciximabgroup(94patients)andin11.0%inthebivalirudingroup(95patients)(relativeriskwithabciximab,0.99;95%confidenceinterval[CI],0.74to1.32;P=0.94).Death,anyrecurrentmyocardialinfarction,orurgenttarget-vesselrevascularizationoccurredin12.8%ofthepatientsintheabciximabgroup(110patients)andin13.4%inthebivalirudingroup(115patients)(relativerisk,0.96;95%CI,0.74to1.25;P=0.76).Majorbleedingoccurredin4.6%ofthepatientsintheabciximabgroup(40patients)ascomparedwith2.6%inthebivalirudingroup(22patients)(relativerisk,1.84;95%CI,1.10to3.07;P=0.02).ConclusionsAbciximabandunfractionatedheparin,ascomparedwithbivalirudin,failedtoreducetherateoftheprimaryendpointandincreasedtheriskofbleedingamongpatientswithnon-ST-segmentelevationmyocardialinfarctionwhowereundergoingPCI.(FundedbyNycomedPharmaandothers;

简介：AbstractBackground:Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56-4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84-0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17-0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33-5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01-1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48-17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83-6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27-0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.

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简介：BackgroundThepresenceofachronictotalocclusion(CTO)inanon-infarct-relatedarterymightbeassociatedwithaworseprognosisinlongtermbenefitforST-segmentelevationmyocardialinfarction(STEIMI)patients.Butitstillremaincontroversial.MethodsAll383STEMIpatientsunderwentpercutaneousintervention(PCI)fromJan2015toJan2017inourcenterwereenrolledinthisprospectivestudy.Baselinecharacteristics,medicalhistory,biochemicalfindings,echocardiographicandangiographicparameters,proceduresperformedandcomplicationswererecorded.FactorsrelatedtoworseoutcomeCTOinSTEMIpatientswereanalyzedbythecoxlogisticregressionanalysisforthehazardrate(HR).ResultsInatotalof383patientsenrolledinthisstudy,85caseshadCTOinatleast1coronaryartery.Themeanfollow-upwas352days.1-yearmortalityandMACEratesinpatientswithCTOwere18.8%and11.8%,respectively.Majoradversecardiacevents(MACE)duringfollow-upweresignificantlyhigherinpatientswithCTO(HR=2.88;95%CI,1.82-4.77;P<0.001).ThemultivariateanalysisshowedasignificantassociationbetweenCTOandMACE(HR=2.1195%CI,1.27-3.88;P=0.014).ConclusionChronictotalocclusionisassociatedwithhigherriskofcomorbiditiesandhighermortality,andservesasanindependentpredictorofMACE.

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简介：Thispaperestablishesanon-linearfiniteelementmodel(NFEM)ofL4-L5lumbarspinalsegmentwithaccuratethree-dimensionalsolidligamentsandintervertebraldisc.Forthepurpose,theintervertebraldiscandsurroundingligamentsaremodeledwithfour-nodalthree-dimensionaltetrahedralelementswithhyper-elasticmaterialproperties.Puremomentof10N·mwithoutpreloadisappliedtotheuppervertebralbodyundertheloadingconditionsoflateralbending,backwardextension,torsion,andforwardfle...

简介：Toinvestigatethebenefitsofintracoronaryhigh-dosetirofibanduringprimarypercutaneouscoronaryintervention(PCI)forpatientswithacuteST-segmentelevationmyocardialinfarction(STEMI).MethodsFifty-eightpatientswithSTEMIpresentedwithin12hofsymptomswererandomlyallocatedtostudygroup(n=28,intracor-onaryhigh-dosetirofiban)andcontrolgroup(n=30,intravenoushigh-dosetirofiban).Theculpritvesselsweretarge-tedwithprimaryPCIinallpatients.Clinicalcharacteristics,angiographicfindings,brainnatriureticpeptide(BNP)at7-dayandin-hospitaloutcomeswerecomparedbetweengroups,aswellasleftventricularejectionfraction(LVEF)andmajoradversecardiacevents(MACE,includingdeath,reinfarction,worseningheartfailureandtargetvesselrevascu-larization)at30-dayclinicalfollow-up.ResultsComparedwiththecontrolgroup,thestudygroupshowedbetterthrombolysisinmyocardialinfarction(TIMI)flowgradesimmediatelyafterPCI(96.4%vs76.7%,P=0.02).The30-daycompositemajoradversecardiaceventsratewaslowerinthestudygroup(3.6%vs23.3%,P=0.02),andtheLVEFandBNPinthestudygroupat7dayswasbetterthanthatinthecontrolgroup(P=0.01and0.02,respec-tively).Nosignificantdifferenceinhemorrhagiccomplicationsinhospitalbetweengroupswasnoted(P=0.61).ConclusionsThestudyindicatesthatintracoronaryhigh-dosebolusadministrationoftirofibanforpatientswithSTEMIwhounderwentprimaryPCIcansignificantlyimprovethereperfusionlevelintheinfarctareaandclinicaloutcomesat30daysfollow-up.Itisbetterandsafertoapplyintravenousbolusinjectionforimprovingcoronaryflow,LVEFandshort-termclinicaloutcomes.

简介：BackgroundLargepercutaneouscoronaryintervention(PCI)centershaveshownstatisticallybetterprognosiswithtransradialapproach(TRA)comparedwithtransfemoralapproach(TFA).SowetriedtocomparetheoutcomesbetweenTRAandTFAinonehighvolumePCIcenterinST-segmentelevationmyocardialinfarction(STEMI)patientsundergoingprimaryPCI.MethodSixhundredandsixtytwoSTEMIpatientswhounderwentprimaryPCIwithstentsimplantationwereretrospectivelyincludedfromJune1,2006toApril30,2011inourhospitalandprospectivelyfollowedforoneyear.Theprimaryendpointwasdefinedasin-hospitalnetadverseclinicalevents(NACE)whichincludeddeath,myocardialinfarction(MI),stroke,targetvesselrevascularization(TVR)andmajorbleeding.Thesecondaryendpointwasdefinedas1yearmajoradversecardiovascularevents(MACE)whichincludeddeath,MIandTVR.ResultsTheoccurrenceratesofNACE(8.0%vs.17.0%,P=0.0018),accesssitecomplications(4.0%vs.10.7%P=0.0027)andaccesssite-relatedmajorbleeding(2.4%vs.6.3%,P=0.0254)wereallhigherintheTFAgroupthanintheTRAgroup.Theincidencerateof1yearMACEwassimilarbetweenTRAandTFA(8.5%vs.13.2%,P=0.0932).TheinverseprobabilitiesweightingmatchedmultivariableCoxregressionanalysisshowedTRAwasanindependentpredictoroflowerratesofin-hospitalNACE(HR:0.58,95%CI:0.34-0.99,P=0.0477),in-hospitaldeath(HR:0.31,95%CI:0.10-0.73,P=0.0499)andaccesssitecomplications(HR:0.37,95%CI:0.19-0.73,P=0.0040).ConclusionsTRAshowedgreatefficacyandsafetyforSTEMIpatientsundergoingprimaryPCIinhighvolumePCIcenters.Itshouldberecommendedasroutinepracticeinfuture,andespeciallyinthosepatientswithhighriskofbleeding.

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简介：摘要：随着网络规模的不断扩大和业务需求的多样化，传统的网络路由技术在高效性、可扩展性和灵活性等方面面临挑战。Segment Routing（SR）作为一种新型的网络路由技术，能够在满足不同业务需求的同时，保持网络架构的简单和高效。本文主要对Segment Routing技术进行了全面的分析与研究，包括其概念、原理、架构设计以及应用场景。