Predictive Value Of Homocysteine For Early Complications In CHD Patients With Percutaneous Coronary Intervention

Objective: Coronary heart disease (CHD) has been thefirst fatal disease for people's lives in the world. In our country,coronary heart disease has also been taking on obviousascending trend nowadays. Since Doctor Gruentzig successfullyapplied the technique of percutaneous transluminal coronaryangioplasty (PTCA) to clinical treatment in September of 1977,percutaneous coronary intervention (PCI) has been one of mainway of treating CHD. The application of PCI has beendeveloped continually with the improvement of apparatus andthe accumulation of operating experience. The success rate hasreached 90% to 95%. However, a series of intraprocedural andpostprocedural complication can occurred in PCI. In recentyears, clinical and experimental studies have demonstrated thathyperhomocysteinemia was closely related with cardiovasculardisease. Homocysteine (Hcy) was believed as an independentrisk factor for atheroscleroses and CHD. This study aims toinvestigate the prognostic value of homocysteine for earlycomplication in CHD patients with PCI and the probablypathogenesis by examination of the plasma levels of Hcy, vonWillebrand factor (vWF), Interleukin-8 (IL-8) and nitric oxide 5英 文 摘 要(NO). Methods: The study population consists of 88 patients whounderwent PTCA and de novo stenting at any one of fourcoronary vessels including LM, LAD, LCX and RAC. 46patients had unstable angina pectoris (UAP) and 42 patients hadstable angina (SAP), at same time 20 patients with normalangiography as controls. Exclusion criteria: total occlusion, left ventricular ejectionfraction <30%, left bundle branch block, valvular heart disease,recent operation and trauma, acute cerebrovascular disease,renal or liver dysfunction, acute and chronic inflammation,acute leukemia, von Willebrand disease, cirrhosis of liver,pulmonary hypertension, bronchial asthma, malnutrition. Age, sex, hypertension, diabetes, myocardial infarction,total cholesterol, triglyceride, HDL-C, LDL-C, and smokingwere recorded in all patients in detail. The same medication ofnitroglycein, angiotensin-converting enzyme inhibitor(ACEI)andβ-recepter antagonist were used in all patients, 300mgaspirin and 150mg clopidogrel were taken for three day beforePCI. Blood sample: peripheral blood samples were taken at thetime of before and 30min, 4h, 12h, 24h, 48h, 72h, 7d after PCI.Coded plasma and serum sample were stored at -80℃ andanalyzed in a single batch at the study. Laboratory assays: vWF, Hcy, and IL-8 were assayed withEnzyme-linked Immunometric Assay, NO was analyzed with 6英 文 摘 要Nitrate Reductase Assay. CK, CK-MB were measured every 24h for three days andelectrocardiogram (ECG) were recorded daily for a week in allpatients after the procedure. Low molecules heparin wasinjected subcutaneously for 3-5days. 150mg aspirin and 75mgclopidogrel were given conventionlly. Definition of early complications: coronary artery abruptocclusion, threatened abrupt occlusion, early recurrence ofischemia, myocardial infarction and sudden cardiac death. Oneof these cases happened at intraprocedural and in-hospitaldefined as early complications. The statistical analysis was performed using the StatisticalPackage for Social Sciences software (SPSS10.0). LogisticRegression Analysis was used to predict the main factors. Pvalue<0.05 was considered statistically significant. Results: The incidence of early complications is 12.5% inthe whole study population. Preprocedural levels of Hcy, Il-8and vWF in UAP were significantly higher than those in SAPand controls. Incidence of early complications in UAP is higherthan that in SAP (p<0.05). Before PCI, the levels of Hcy, Il-8,vWF were significantly higher in patients with earlycomplications than those in patients without early complications(P<0.05), the level of NO was lower in patients with earlycompli...