Pulmonary embolism secondary to acute anterior ST-elevation myocardial infarction:a case report

Thrombophilia denotes a condition,whether acquired or hereditary,characterized by increased susceptibility to hypercoagulation.[1]This condition was first described in 1965,coinciding with the discovery of an inherited predisposition to venous thromboembolism(VTE)in patients deficient in antithrombin III.[2]While arterial and venous thromboses are common in hospitalized patients,acute myocardial infarction(AMI)and pulmonary embolism(PE)stand out as lifethreateningconditions.However,theoccurrenceof AMI complicated by PE is exceedingly rare,especially when considering cases where paradoxical embolism originating from a patent foramen ovale is absent.This report presents a case of AMI complicated with PE.A comprehensive understanding of the pathophysiology of this rare yet critical condition is important for ensuring prompt diagnosis and treatment.

Patients with ST-segment elevation of myocardial infarction miss out on early reperfusion： when to undergo delayed revascularization

Objective There are still a high proportion of patients with ST-segment elevation myocardial infarction （STEMI） missing out early reperfusion even in the primary percutaneous coronary intervention （PCI） era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial. Methods We investigated all STEMI patients who underwent delayed PCI （2-28 days after STEMI） during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was maj or adverse cardiovascular events （MACEs）. Results This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time （Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%）. During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death （hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, P = 0.030） than Late group and less repeat revascularization （hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, P = 0.007） than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event （MACE） by delayed time as a quadratic curve and found the bottom appeared at day 14. Conclusions The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.

Impact of meteorological conditions and PM2.5 on the onset of acute aortic dissection in monsoonal climate

Objective To investigate the impact of meteorological conditions and PM2.5 on the onset of acute aortic dissection in monsoonal climate. Methods A linear regression analysis was performed in monsoonal climate epidemiological survey for a period of four years on the impact of meteorological factors （minimal temperature, mean temperature, maximal temperature, average daily surface temperature, day temperature range, relative humidity, mean wind speed, and atmospheric pressure） and PM2.5 concentration on the daily incidences of acute aortic dissections. Meteorological variables and PM2.5 concentration were retrieved on a daily basis from Beijing Regional Climate Center and the Ministry of Environmental Protection of the People’s Republic of China’s website, and the daily incidences of acute aortic dissections were retrieved from the Clinical Data Analysis and Reporting System in the Emergency and Critical Care Center of Beijing Anzhen Hospital. Results During the study period （from January 2011 to December 2014）, 1164 patients were identified as having acute aortic dissections. The corresponding incidences in spring and autumn were 0.96 and 1.00, respectively, which significantly higher than that in summer and winter. The incidences of acute aortic dissection in a day could be predicted by diurnal temperature range （DTR） using the following linear multiple regression models： incidences of acute aortic dissection = 0.543 ＋ 0.025 × DTR. Conclusion This is the first study to show an attributable effect of DTR on acute aortic events in monsoonal climate. Our study confirms that meteorological variables were important factors influencing the incidence of acute aortic dissection.

Characteristics, Management, and Outcomes of Acute Heart Failure in the Emergency Department： A Multicenter Registry Study with 1-year Follow-up in a Chinese Cohort in Beijing

Background： The emergency department （ED） has a pivotal influence on the management of acute heart failure （AHF）, but dataconcerning current ED management are scarce. This Beijing AHF Registry Study investigated the characteristics. ED management, and short- and long-term clinical outcomes of AHF. Methods： This prospective, multicenter, observational study consecutively enrolled 3335 AHF patients who visited 14 EDs in Beijing from January 1, 2011, to September 23, 2012. Baseline data on characteristics and management were collected in the EDs. Follow-up data on death and readmissions were collected until November 31, 2013, with a response rate of 92.80%. The data were reported as median （interquartile range） for the continuous variables, or as number （percentage） for the categorical variables. Results： The median age of the enrolled patients was 71 （58 79） years, and 46.84% wvere women. In patients with AHH coronary heart disease （43.27%） was the most common etiology, andmyocardium ischemia （30.22%） was the main precipitant. Most of the patients in the ED received intravenous treatments, including diuretics （79.28%） and vasodilators （74.90%）. Fewer patients in the ED received neurohormonal antagonists, and 25.94%, 31.12%, and 33.73% of patients received angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and spironolactone, respectively. The proportions of patients who were admitted, discharged, left against medical advice, and died were 55.53%, 33.58%, 7.08%, and 3.81%, respectively. All-cause mortalities at 30 days and 1 year were 15.30% and 32.27%, respectively. Conclusions： Substantial details on characteristics and ED management of AHF were investigated. The clinical outcomes of AHF patients were dismal. Thus, further investigations of ED-based therapeutic approaches for AHF are needed.

Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

Background： Previous studies showed that patients with cardiogenic shock （CS） from ST-elevation acute myocardial infarction （STEMI） supported by intra-aortic balloon pump （IABP） before primary percutaneous coronary intervention （PCI） decreased the risk of in-hospital mortality than patients who received IABP after PCI. However, little evidence is available on the optimal order of IABP insertion and primary PCI. The aim of this study was to investigate the impact of the sequence of IABP support and PC1 and its association with major adverse cardiac and cerebrovascular events （MACCEs）. Methods： Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014% who were treated with 1ABP and PCI. The patients were divided into two groups： Group A in whom IABP received before PCI （n = 106） and Group B in whom IABP received after PCI （n = 112）. We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation. The primary endpoint was 12-month risk of MACCE. Results： Most baseline characteristics were similar in patients between the two groups. However, patients received 1ABP before PCI were associated with a delay of door-to-balloon time （DBT） and higher troponin I level （P 〈 0.05）. However, myocardial perfusion was significantly improved in patients treated with IABP before PCI （P 〈 0.05）. Overall, IABP support before PCI was not associated with significantly lower risk of MACCE （P 〉 0.05）. In addition, risk of all-cause mortality, bleeding, and acute kidney injury （AKI） was similar between two groups （P 〉 0.05）. Multivariate analysis showed that DBT （odds ratio [OR] 2.5, 95% confidence interval [C/] 1.1-4.8, P=0.04）, lABP support after PCI （OR 5.7, 95% Cl 2.7-8.4, p〈0.01）, and AKI （OR 7.4, 95% CI 4.9 10.8, P- 0.01） were the independent predictors of mortality at 12-month follow-up. Conclusions： Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT increases. IABP support before PCI does not confer a 12-month clinical benefit when used for STEMI with CS.