BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the l...BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the long-term prognostic impact of complete revascularization in this population.METHODS We conducted this study using data obtained from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry,which was carried out from 2003 to 2014.The objective was to categorize older patients diagnosed with ACS into two groups:those who underwent complete revascularization and those who did not.Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes.The primary endpoint was major adverse cardiovascular event(MACE),which encompassed a combination of all-cause mortality and myocardial infarction.RESULTS Out of 1263 patients evaluated,445 patients(35.2%)received complete revascularization.Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not.During the one-year follow-up period,complete revascularization was associated with a significantly decreased risk of MACE[13.7%vs.20.5%,hazard ratio(HR)=0.63,95%CI:0.45–0.88,P=0.007]and a lower risk of myocardial infarction(5.9%vs.9.9%,HR=0.55,95%CI:0.33–0.92,P=0.02).However,it was not linked to a lower risk of all-cause death(9.5%vs.13.5%,HR=0.68,95%CI:0.45–1.02,P=0.06).Similar results were observed in the subgroup analysis.CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization.Therefore,adhering to guidelines for complete revascularization should be recommended for elderly patients.展开更多
OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases w...OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020,and meta-analysis was performed by STATA software(version 15.1).Using standardized data-collection forms,the authors screened the studies and independently extracted data,and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies.Cohort studies that examined the following results were included in the current study:in-hospital mortality,all-cause bleeding rate,gastrointestinal bleeding rate,intracranial hemorrhage rate,the incidence of shock,and hospital length of stay.RESULTS A total of eight articles,with 13,242 participants,involving 3962 participants in the CDT group and 9280 participants in the ST group were included.CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate[odds ratio(OR)=0.41,95%CI:0.30–0.56,P<0.05],all-cause bleeding rate(OR=1.20,95%CI:1.04–1.39,P=0.012),gastrointestinal bleeding rate(OR=1.43,95%CI:1.13–1.81,P=0.003),the incidence of shock(OR=0.46,95%CI:0.37–0.57,P<0.05),and hospital length of stay[standard mean difference(SMD)=0.16,95%CI:0.07–0.25,P<0.05].However,there was no significant effect on intracranial hemorrhage rate in patients with PE(OR=0.70,95%CI:0.47–1.03,P=0.070).CONCLUSIONS CDT is a viable alternative to ST in the treatment of PE,as it can significantly reduce in-hospital mortality rate,all-cause bleeding rate,gastrointestinal bleeding rate,and incidence of shock.However,CDT may prolong hospital length of stay to a certain extent.Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.展开更多
The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple dise...The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].展开更多
BackgroundAcute 肾损害(AKI ) 在为尖锐大动脉的解剖(AAD ) 的外科以后是普通的并且增加在里面医院和长期的死亡。然而，很少数据与类型在病人在早外科手术前的 AKI 的临床、预示的关联上存在 AAD。我们试图在病人在在里面医院结果上...BackgroundAcute 肾损害(AKI ) 在为尖锐大动脉的解剖(AAD ) 的外科以后是普通的并且增加在里面医院和长期的死亡。然而，很少数据与类型在病人在早外科手术前的 AKI 的临床、预示的关联上存在 AAD。我们试图在病人在在里面医院结果上决定外科手术前的 AKI 的发生和 AKI 的影响与打阿德梅索兹夫罗姆·梅 2009 到 2014 年 6 月，我们回顾地注册了为类型从症状发作和收到的开的外科在 48 h 以内进入我们的医院的 178 个病人 AAD。病人被划分成没有 AKI 和 AKI 组并且在 surgery.ResultsAKI 发生在 41 个病人(23.0%) 以前，根据 KDIGO 标准与 AKI 上演了严厉。在里面医院复杂并发症的发生在有与没有 AKI 相比的外科手术前的 AKI 的病人是显著地更高的(41.5% 对 9.5% ， P <；0.001 ) ，包括肾的梗塞(7.3% 对 0， P = 0.012 ) ，并且它与 AKI 严厉增加了(P <sub > 趋势 </sub><；0.001 ) 。尽管没有重要差别被发现，没有 AKI，有 AKI 的病人与病人相比有更高的在里面医院死亡(14.6% 对 5.1% ， P = 0.079 ) 。Multivariate 分析显示那男性，承认上的心脏舒张的血压和双边的肾的动脉参与 AAD.ConclusionsEarly 是在有类型 A 的病人的外科手术前的 AKI 的独立预言者在外科前的 AKI 在有类型的病人是普通的 AAD，并且与增加的在里面医院复杂并发症被联系。男性，承认上的心脏舒张的血压和双边的肾的动脉参与是为外科手术前的 AKI 的主要预言者。展开更多
Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute C...Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.展开更多
Intermediate-and high-risk pulmonary embolism(PE)is a life-threatening medical emergency with high morbidity and mortality.Many of the treatment options for PE involve clinicians from multiple disciplines.Pulmonary Em...Intermediate-and high-risk pulmonary embolism(PE)is a life-threatening medical emergency with high morbidity and mortality.Many of the treatment options for PE involve clinicians from multiple disciplines.Pulmonary Embolism Response Teams(PERTs)have been developed to coordinate the multidisciplinary team of clinicians to streamline the decision making process and develop individualised treatment plans in a timely fashion.The first PERT was established in 2012 and subsequently multiple centres worldwide have introduced this model for the management of intermediate-and high-risk PE.In this review,we evaluate the organisational structure and algorithms of different PERT services and compare data from pre-and post-PERT services to determine the impact of PERT on outcomes.We consider the cost and time implications of this multidisciplinary 24-hour service and suggest areas for further research and review.展开更多
Acute myocardial infarction complicated by cardiogenic shock and left main coronary artery disease is called left main shock syndrome. It is reported that the morbility and mortality of the syndrome is approximately 0...Acute myocardial infarction complicated by cardiogenic shock and left main coronary artery disease is called left main shock syndrome. It is reported that the morbility and mortality of the syndrome is approximately 0.46%and 55%-80%, respectively. However, the best treat-ment strategy in these cases is unknown. In this article, we present a patient with LMSS who successively underwent emergency percutane-ous coronary intervention and coronary artery bypass grafting with hemodynamic support within 5 days. The patient is now on his three month uneventful out-patient follow-up.展开更多
Iatrogenic aortocoronary dissection(IACD)is a rare but potentially life-threatening complication during coronary catheterizations.Although the incidence was relatively low,the dissection often leads to procedure failu...Iatrogenic aortocoronary dissection(IACD)is a rare but potentially life-threatening complication during coronary catheterizations.Although the incidence was relatively low,the dissection often leads to procedure failure with increased risk of myocardial infarction and death.IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures,and appears as luminal filling defects or persistence of contrast(“extraluminal cap”)or intimal tear outside the coronary lumen.Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen.Similarly,it could extend retrogradely into the sinus of Valsalva and cusp,or even the ascending aorta,aortic arch,or descending aorta,leading to hemodynamic collapse.Early identifi cation and prompt management is crucial to the prognosis of patients with IACD.Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection,even when signifi cant propagation has already occurred.Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.展开更多
BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficientl...BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficiently investigated.This study aimed to examine the association between in-hospital haemoglobin drop and risk for adverse clinical outcomes in ACS patients,especially those with mild drop.METHODS Included patients from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry were categorized into three groups by the presence and amount of in-hospital haemoglobin drop(non-drop,mild drop and severe drop).The cut-off point between mild drop and severe drop is≥3 g/dL.Multivariate Cox regression was used to assess the association between haemoglobin drop and major adverse cardiac endpoints(MACE).Patients taking potent P2Y_(12) inhibitors were selected for the additional analysis.Propensity score matching was used to avoid selective bias in the additional analysis.RESULTS Of 6911 patients,4949 patients(71.6%)experienced in-hospital haemoglobin drop.Compare with non-drop group,patients with haemoglobin drop had higher risk of MACE[adjusted hazard ratio(HR)=1.36,95%CI:1.03–1.80 for mild drop group;adjusted HR=1.70,95%CI:1.07–2.68 for severe drop group].Patients in mild drop group were less likely to receive potent P2Y_(12) inhibitors at discharge(mild drop group vs.severe drop group vs.non-drop group:10.9%vs.10.7%vs.23.8%).After propensity score matching adjustment among patients with potent P2Y_(12) inhibitors,patients in mild drop group were not associated with an increased risk of MACE than those in non-drop group(adjusted HR=1.52,95%CI:0.49–4.72).CONCLUSIONS In-hospital haemoglobin drop was common in ACS patients and associated with a higher risk for adverse events.Reduced prescription for potent P2Y_(12) inhibitors may be responsible for poor prognoses among patients with mild haemoglobin drop.展开更多
The prevalence of type 2 diabetes(T2D)has escalated to a global epidemic,garnering widespread concern.Tremendous research utilizing germ-free(GF)mice,antibiotic treatments,and fecal microbiota transplantation approach...The prevalence of type 2 diabetes(T2D)has escalated to a global epidemic,garnering widespread concern.Tremendous research utilizing germ-free(GF)mice,antibiotic treatments,and fecal microbiota transplantation approaches has established the critical role of gut microbiota in modulating glucose metabolism.The microbiota interacts with diets and the mucosal immune system,influencing intestinal permeability and the penetration of microbial products.展开更多
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 coro...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.展开更多
基金supported by the Ministry of Science and Technology of China(2020YFC2004800)the National Natural Science Foundation of China(No.82100260)the Beijing Hospitals Authority Youth Program(QML20210605)。
文摘BACKGROUND The prognostic benefit of complete revascularization in elderly patients(aged over 75 years)with multi-vessel disease and acute coronary syndrome(ACS)is currently unclear.This study aimed to determine the long-term prognostic impact of complete revascularization in this population.METHODS We conducted this study using data obtained from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry,which was carried out from 2003 to 2014.The objective was to categorize older patients diagnosed with ACS into two groups:those who underwent complete revascularization and those who did not.Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes.The primary endpoint was major adverse cardiovascular event(MACE),which encompassed a combination of all-cause mortality and myocardial infarction.RESULTS Out of 1263 patients evaluated,445 patients(35.2%)received complete revascularization.Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not.During the one-year follow-up period,complete revascularization was associated with a significantly decreased risk of MACE[13.7%vs.20.5%,hazard ratio(HR)=0.63,95%CI:0.45–0.88,P=0.007]and a lower risk of myocardial infarction(5.9%vs.9.9%,HR=0.55,95%CI:0.33–0.92,P=0.02).However,it was not linked to a lower risk of all-cause death(9.5%vs.13.5%,HR=0.68,95%CI:0.45–1.02,P=0.06).Similar results were observed in the subgroup analysis.CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization.Therefore,adhering to guidelines for complete revascularization should be recommended for elderly patients.
基金This study was supported by the National Natural Science Foundation of China(No.82270258)the National Key R&D Program of China(2020YFC2004800)+1 种基金the Beijing Hospitals Authority Incubating Program(PZ2022004)the Beijing Municipal Science and Technology Committee(Z221100003522027).
文摘OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020,and meta-analysis was performed by STATA software(version 15.1).Using standardized data-collection forms,the authors screened the studies and independently extracted data,and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort studies.Cohort studies that examined the following results were included in the current study:in-hospital mortality,all-cause bleeding rate,gastrointestinal bleeding rate,intracranial hemorrhage rate,the incidence of shock,and hospital length of stay.RESULTS A total of eight articles,with 13,242 participants,involving 3962 participants in the CDT group and 9280 participants in the ST group were included.CDT compared with ST in the treatment of PE can significantly affect in-hospital mortality rate[odds ratio(OR)=0.41,95%CI:0.30–0.56,P<0.05],all-cause bleeding rate(OR=1.20,95%CI:1.04–1.39,P=0.012),gastrointestinal bleeding rate(OR=1.43,95%CI:1.13–1.81,P=0.003),the incidence of shock(OR=0.46,95%CI:0.37–0.57,P<0.05),and hospital length of stay[standard mean difference(SMD)=0.16,95%CI:0.07–0.25,P<0.05].However,there was no significant effect on intracranial hemorrhage rate in patients with PE(OR=0.70,95%CI:0.47–1.03,P=0.070).CONCLUSIONS CDT is a viable alternative to ST in the treatment of PE,as it can significantly reduce in-hospital mortality rate,all-cause bleeding rate,gastrointestinal bleeding rate,and incidence of shock.However,CDT may prolong hospital length of stay to a certain extent.Further research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.
基金the National Key R&D Program of China(2020YFC2004800).
文摘The present protocol describes an observational cohort study that was designed to propose a therapeutic scheme and formulate an individualized treatment strategy for frail elderly patients diagnosed with multiple diseases in a Chinese,multicenter setting.Over a 3-year period,we will recruit 30,000 patients from 10 hospitals and collect baseline data including patient demographic information,comorbidity characteristic,FRAIL scale,age-adjusted Charlson comorbidity index(aCCI),relevant blood tests,the results of imaging examination,prescription of drugs,length of hospital stay,number of overall re-hospitalizations and death.Elderly patients(≥65 years old)with multimorbidity and receiving hospital care are eligible for this study.Data collection is being performed at baseline and 3,6,9 and 12 months after discharge.Our primary analysis was all-cause death,readmission rate and clinical events(including emergency visits,stroke,heart failure,myocardial infarction,tumor,acute chronic obstructive pulmonary disease,etc).The study is approved by the National Key R&D Program of China(2020YFC2004800).Data will be disseminated in manuscripts submitted to medical journals and in abstracts submitted to international geriatric conferences.Clinical Trial Registration:[www.ClinicalTrials.gov],identifier[ChiCTR2200056070].
基金This study was supported in part by grants fi＇om the Bei- jing Natural Science Foundation （7141003） and Beijing Municipal Science ＆ Technology Commission （Z14110- 7002514014）.
文摘ObjectiveAcute 肾损害(AKI ) 经常发生在基于导管的 interventional 过程和增加死亡以后。然而，类型 B 尖锐大动脉的解剖(AAD ) 的 AKI 以前胸的 endovascular 动脉瘤修理(TEVAR ) 的含意仍然保持不清楚。这研究与类型 B AAD.MethodsBetween 2009 在病人在 TEVAR 前评估了 AKI 的发生，预言者，和在里面医院结果并且 2013， 76 个病人回顾地被评估从症状发作在 36 h 以内为类型 B AAD 收到了 TEVAR。病人被分类进 no-AKI 对 AKI 组，并且 AKI 的严厉进一步根据肾疾病被上演：在外科手术前的 AKI 的 TEVAR.ResultsThe 发生前改进全球结果标准是 36.8% 。在里面医院复杂并发症与 no-AKI 相比在有外科手术前的 AKI 的病人是显著地更高的(50.0% 对 4.2% 分别地；P <；0.001 ) ，包括尖锐肾的失败(21.4% 对 0 分别地；P <；0.001 ) ，并且他们与 AKI 的严厉增加了(P <；0.001 ) 。身体温度和白血房间计数的最大的层次是以前显著地与最大的浆液 creatinine 有关铺平 TEVAR。Multivariate 分析在承认上显示出那收缩血压(或：1.023；95% CI：1.003-1.044；P = 0.0238 ) 并且双边的肾的动脉参与(或：19.076；95% CI：1.914-190.164；P = 0.0120 ) 外科手术前的 AKI.ConclusionsPreoperative AKI 的强壮的预言者经常与类型 B AAD 在病人被发生，并且与更高的在里面医院复杂并发症相关并且提高了煽动性的反应。承认和双边的肾的动脉参与上的收缩血压是为在 TEVAR 前的 AKI 的主要风险因素。
基金This study was supported in part by grants from the Beijing Natural Science Foundation （7141003）, Beijing Municipal Science ＆ Technology Commission （Z14110700 2514014）, and Beijing Municipal Administration of Hospitals Incubating Program （PX2016048）.
文摘BackgroundAcute 肾损害(AKI ) 在为尖锐大动脉的解剖(AAD ) 的外科以后是普通的并且增加在里面医院和长期的死亡。然而，很少数据与类型在病人在早外科手术前的 AKI 的临床、预示的关联上存在 AAD。我们试图在病人在在里面医院结果上决定外科手术前的 AKI 的发生和 AKI 的影响与打阿德梅索兹夫罗姆·梅 2009 到 2014 年 6 月，我们回顾地注册了为类型从症状发作和收到的开的外科在 48 h 以内进入我们的医院的 178 个病人 AAD。病人被划分成没有 AKI 和 AKI 组并且在 surgery.ResultsAKI 发生在 41 个病人(23.0%) 以前，根据 KDIGO 标准与 AKI 上演了严厉。在里面医院复杂并发症的发生在有与没有 AKI 相比的外科手术前的 AKI 的病人是显著地更高的(41.5% 对 9.5% ， P <；0.001 ) ，包括肾的梗塞(7.3% 对 0， P = 0.012 ) ，并且它与 AKI 严厉增加了(P <sub > 趋势 </sub><；0.001 ) 。尽管没有重要差别被发现，没有 AKI，有 AKI 的病人与病人相比有更高的在里面医院死亡(14.6% 对 5.1% ， P = 0.079 ) 。Multivariate 分析显示那男性，承认上的心脏舒张的血压和双边的肾的动脉参与 AAD.ConclusionsEarly 是在有类型 A 的病人的外科手术前的 AKI 的独立预言者在外科前的 AKI 在有类型的病人是普通的 AAD，并且与增加的在里面医院复杂并发症被联系。男性，承认上的心脏舒张的血压和双边的肾的动脉参与是为外科手术前的 AKI 的主要预言者。
基金supported by the Capital Health Research and Development of Special Foundation (2018-1-2061)
文摘Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140. Methods A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140. Results Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1%± 6.9% vs. 61.5%± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74–0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively;the positive predictive value was 20% and the negative predictive value was 99%. Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.
基金supported by the National Natural Science Foundation of China(No.81670222)Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support(ZYLX201710)+4 种基金Beijing Municipal Administration of Hospitals’Ascent Plan(DFL20180601)Beijing Lab for Cardiovascular Precision MedicineBeijingChina(PXM2018_014226_000013)the Capital Health Research and Development of Special Fund(2018-1-2061)。
文摘Intermediate-and high-risk pulmonary embolism(PE)is a life-threatening medical emergency with high morbidity and mortality.Many of the treatment options for PE involve clinicians from multiple disciplines.Pulmonary Embolism Response Teams(PERTs)have been developed to coordinate the multidisciplinary team of clinicians to streamline the decision making process and develop individualised treatment plans in a timely fashion.The first PERT was established in 2012 and subsequently multiple centres worldwide have introduced this model for the management of intermediate-and high-risk PE.In this review,we evaluate the organisational structure and algorithms of different PERT services and compare data from pre-and post-PERT services to determine the impact of PERT on outcomes.We consider the cost and time implications of this multidisciplinary 24-hour service and suggest areas for further research and review.
基金This study was supported by National Science Foundation Council of China （No.81700383）, Jilin Provincial Industrial Innovation Special Fund Project （No.2016C041）, Beijing Natural Science Foundation of China （8152019）, Beijing Municipal Science and Technology of Chinese Medicine Development Funds Youth Research Project （No. QN2016-20）, and Basic-Clinical Scientific Research Cooperation of Capital Medical University fund （No.17JL72）. The authors declare no conflict of interest.
文摘Acute myocardial infarction complicated by cardiogenic shock and left main coronary artery disease is called left main shock syndrome. It is reported that the morbility and mortality of the syndrome is approximately 0.46%and 55%-80%, respectively. However, the best treat-ment strategy in these cases is unknown. In this article, we present a patient with LMSS who successively underwent emergency percutane-ous coronary intervention and coronary artery bypass grafting with hemodynamic support within 5 days. The patient is now on his three month uneventful out-patient follow-up.
基金This study was supported in part by grants from the Beijing Natural Science Foundation(7141003)Beijing Municipal Science&Technology Commission(Z141107002514014).
文摘Iatrogenic aortocoronary dissection(IACD)is a rare but potentially life-threatening complication during coronary catheterizations.Although the incidence was relatively low,the dissection often leads to procedure failure with increased risk of myocardial infarction and death.IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures,and appears as luminal filling defects or persistence of contrast(“extraluminal cap”)or intimal tear outside the coronary lumen.Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen.Similarly,it could extend retrogradely into the sinus of Valsalva and cusp,or even the ascending aorta,aortic arch,or descending aorta,leading to hemodynamic collapse.Early identifi cation and prompt management is crucial to the prognosis of patients with IACD.Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection,even when signifi cant propagation has already occurred.Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.
文摘BACKGROUND Haemoglobin drop is common in acute coronary syndrome(ACS)patients and correlates with poor prognosis.However,the association between mild haemoglobin drop and adverse clinical outcome remains insufficiently investigated.This study aimed to examine the association between in-hospital haemoglobin drop and risk for adverse clinical outcomes in ACS patients,especially those with mild drop.METHODS Included patients from the BleeMACS(Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome)registry were categorized into three groups by the presence and amount of in-hospital haemoglobin drop(non-drop,mild drop and severe drop).The cut-off point between mild drop and severe drop is≥3 g/dL.Multivariate Cox regression was used to assess the association between haemoglobin drop and major adverse cardiac endpoints(MACE).Patients taking potent P2Y_(12) inhibitors were selected for the additional analysis.Propensity score matching was used to avoid selective bias in the additional analysis.RESULTS Of 6911 patients,4949 patients(71.6%)experienced in-hospital haemoglobin drop.Compare with non-drop group,patients with haemoglobin drop had higher risk of MACE[adjusted hazard ratio(HR)=1.36,95%CI:1.03–1.80 for mild drop group;adjusted HR=1.70,95%CI:1.07–2.68 for severe drop group].Patients in mild drop group were less likely to receive potent P2Y_(12) inhibitors at discharge(mild drop group vs.severe drop group vs.non-drop group:10.9%vs.10.7%vs.23.8%).After propensity score matching adjustment among patients with potent P2Y_(12) inhibitors,patients in mild drop group were not associated with an increased risk of MACE than those in non-drop group(adjusted HR=1.52,95%CI:0.49–4.72).CONCLUSIONS In-hospital haemoglobin drop was common in ACS patients and associated with a higher risk for adverse events.Reduced prescription for potent P2Y_(12) inhibitors may be responsible for poor prognoses among patients with mild haemoglobin drop.
基金supported by the National Natural Science Foundation of China for Distinguished Young Scholars(31825020)the National Natural Science Foundation of China for the Key Project of International Cooperative Research(32120103012)+1 种基金the Key Technological Project of Jiangxi Province(20212AAF01005)Key Laboratory of Bioactive Polysaccharides of Jiangxi Province(20212BCD42016)。
文摘The prevalence of type 2 diabetes(T2D)has escalated to a global epidemic,garnering widespread concern.Tremendous research utilizing germ-free(GF)mice,antibiotic treatments,and fecal microbiota transplantation approaches has established the critical role of gut microbiota in modulating glucose metabolism.The microbiota interacts with diets and the mucosal immune system,influencing intestinal permeability and the penetration of microbial products.
文摘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.
