The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction

BACKGROUND:The early diagnosis of acute myocardial infarction(AMI)remains challenging,especially for institutions without the high-sensitive cardiac troponin(hs-c Tn)assay.Herein,we aim to assess the value of creatine kinase-myocardial band isoenzyme(CK-MB)combined with different cardiac troponin(c Tn)assays in AMI diagnosis.METHODS:This multicenter,observational study included 3,706 patients with acute chest pain from September 1,2015,to September 30,2017.We classified the participants into three groups according to the c Tn assays:the point-of-care c Tn(POC-c Tn)group,the contemporary c Tn(c-c Tn)group,and hs-c Tn group.The diagnostic value was quantified using sensitivity and the area under the curve(AUC).RESULTS:Compared to the single POC-c Tn/c-c Tn assays,combining CK-MB and POC-c Tn/c-c Tn increased the diagnostic sensitivity of AMI(56.1%vs.63.9%,P<0.001;82.7%vs.84.3%,P=0.025).In contrast,combining CK-MB and hs-c Tn did not change the sensitivity compared with hs-c Tn alone(95.0%vs.95.0%,P>0.999).In the subgroup analysis,the sensitivity of combining CKMB and c-c Tn increased with time from symptom onset<6 h compared with c-c Tn alone(72.8%vs.75.0%,P=0.046),while the sensitivity did not increase with time from symptom onset>6 h(97.5%vs.98.3%,P=0.317).The AUC of the combination of CK-MB and POC-c Tn significantly increased compared to the single POC-c Tn assay(0.776 vs.0.750,P=0.002).The AUC of the combined CKMB and c-c Tn/hs-c Tn assays did not significantly decrease compared with that of the single c-c Tn/hs-c Tn assays within 6 h.CONCLUSIONS:The combination of CK-MB and POC-c Tn or c-c Tn may be valuable for the early diagnosis of AMI,especially when hs-c Tn is not available.

Effect of Ti Addition on Microstructure Evolution and Mechanical Properties of Al_(18)Co_(13)Cr_(10)Fe_(14)Ni_(45) Eutectic High-Entropy Alloys

A series of new(Al_(18)Co_(13)Cr_(10)Fe_(14)Ni_(45))(100−x)Tix(x=0,0.5,1)eutectic high-entropy alloys(EHEAs)were designed and prepared with the aid of empirical parameter calculations and JMatPro software predictions.The effects of Ti addition on the microstructures,phase structures,and mechanical properties of Al_(18)Co_(13)Cr_(10)Fe_(14)Ni_(45) EHEA were investigated.The results show that(Al_(18)Co_(13)Cr_(10)Fe_(14)Ni_(45))_((100−x))Ti_(x)(x=0,0.5,1)EHEAs are composed of the FCC and B2 phases.With the increase in Ti content,the strength of the EHEAs increases.The volume fraction of the FCC phase decreases,and the volume fraction of B2 phase increases;the size of nanoprecipitates within the B2 phase decreases and the number of them increases,which could be responsible for the high strength due to the addition of Ti.Among them,(Al_(18)Co_(13)Cr_(10)Fe_(14)Ni_(45))99.5Ti0.5 alloy exhibited excellent properties with yield strength,ultimate tensile strength,and ductility of 690 MPa,1065 MPa,and 9.18%,respectively.

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention(PCI)is associated with higher mortality rates after STsegment 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[Cl]1.56-4.52,P<0.001),low body mass index(BMI)(OR 0.91,95%Cl 0.84-0.98,P=0.013),not being married(OR 0.29,95%Cl 0.17-0.49,P<0.001),history of myocardial infarction(MI)(OR 2.59,95%Cl 1.33-5.04,P=0.005),higher heart rate(HR)(OR 1.02,95%Cl 1.01-1.03,P=0.002),cardiac shock in the ED(OR 5.03,95%Cl 1.48-17.08,P=0.010),pre-hospital delay(>12 h)(OR 3.31,95%Cl 1.83-6.02,P<0.001)and not being hospitalized in a tertiary hospital(OR 0.45,95%Cl 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.