1.Two Cases Of Coronary Stent Thrombosis2.Therapy For Secondary Prevention In Patients With Coronary Heart Disease

Coronary stent thrombosis (Stent Thrombosis, ST) is a rare but devastating complication of percutaneous coronary intervention (Percutaneous Coronary Intervention, PCI). Although the estimated prevalence is1%, it associates with high mortality and morbidity by causing unstable angina pectoris (Unstable Angina Pectoris, UAP), acute myocardial infarction (Acute Myocardial Infarction, AMI), heart failure (Heart Failure, HF) and even sudden death. The standard definition of ST by Academic Research Consortium (Academic Research Consortium, ARC) ranges from definite ST, probable ST and possible ST according to the coronary artery angiography (Coronary Artery Angiography, CAG) and clinical manifestation. The second classification principle is based on the time of the adverse events relative to the index procedure which ranges from acute ST, subacute ST, late ST and very late ST. Large numbers of clinical trials have confirmed that ST is a multifactorial problem related to stent, patient, lesions, procedural factors and drug therapy. Once occurred, emergency PCI is the best therapy of choice. Besides, regular antiplatelet therapy, stent selection and deployment, the selection of patients and lesions, improving procedural technique and patient care are all the important measures to prevent ST. Here we report two cases of ST after the PCI by3months and8months. Both of them presented as AMI and were proved by CAG. The patients received new stent implantation, revascularization and the situations were well controlled. In out text, we also reviewed standard definition, current understanding of pathogenesis, related factors, clinical manifestation, therapeutic options and preventive strategy of ST. [Objective]:To investigate therapy for secondary prevention in patients with different types of coronary heart disease (Coronary Heart Disease, CHD) and the gap between guidelines.[Methods]:This was a retrospective study, which enrolled2000cases from the First Affiliated Hospital of College of Medicine, Zhejiang University from June2012to June2013. We calculated the status of aspirin, clopidogrel, dual anti-platelet, β blockers, angiotensin converting enzyme inhibitor/angiotensin receptor blocker (Angiotensin Converting Enzyme Inhibitor/Angiotensin Receptor Blocker, ACEI/ARB), statins and calcium channel blocker (Calcium Channel Blocker, CCB) use.[Results]:The frequency of patients who took standard medication of aspirin, β blockers, clopidogrel, dual anti-platelet, ACEI/ARB and statins was95.4%,97.3%,92.8%,65.9%,54.4%and96.5%.The frequency of CCB use was25.7%.[Conclusions]: The use status of aspirin, clopidogrel, dual anti-platelet and statins was good and close to the guidelines, while there was great gap for therapy of β blockers and ACEI/ARB. There was no significant difference of drug use among different types of CHD. But different types of treatments had significant influence on the therapy.