BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relations...BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.展开更多
Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one ca...Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.展开更多
The best time of stem cells transplantation for treating acute myocardial infarction (AMI) is still to be followed with interest and a focus issue for clinical cardiologist. A brief meta-analysis of clinical trials ab...The best time of stem cells transplantation for treating acute myocardial infarction (AMI) is still to be followed with interest and a focus issue for clinical cardiologist. A brief meta-analysis of clinical trials about timing-window and therapeutic effects of stem cell transplantation for treating AMI will be made out in this article.展开更多
SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledg...SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledge of the various forms of presentation are mandatory for optimal medical therapy. We present a case report of a 45-year-old patient who was admitted to the coronary unit showing symptoms and laboratory tests compatible with myocardial infarction. Complete diagnosis was obtained only with more specific exams. The manifestations of the disease in the case described and the main features of the disease are discussed.展开更多
Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI) , but the safety of intracoronory infusion of autologous peripheral blood ...Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI) , but the safety of intracoronory infusion of autologous peripheral blood stem-cell (PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients. Methods 41 patients with AMI were allocated to receive granulocyte colony-stimulating factor (G- CSF: Filgrastim,300μg) with the dose of 300μg~ 600μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cel 1 separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA) by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block, premature ve. ntricular beats ,ven~icular tachycardia, ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4% (10/41), including bradyca- rdia was 2.4 % (1/41), sinus arrest or atrial ventri- cular block was 4.0% (2/41), ventricular fibrillation was 2.4 % (1/41), hypotention was 14.6 % (6/41). Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.展开更多
Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an a...Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.展开更多
To assess the optimal dose of aspirin （ASA） in the treatment of AMI, 60 cases of AMI: 1. admitted within 24 hours after onset of illness, 2. ASA not used within one week before, 3. any other drugs influencing the pl...To assess the optimal dose of aspirin （ASA） in the treatment of AMI, 60 cases of AMI: 1. admitted within 24 hours after onset of illness, 2. ASA not used within one week before, 3. any other drugs influencing the platelet function also not used during the course of study, were randomized into two groups, 30 cases each: one with conventional therapy as control, the other combined with daily oral ASA 100mg. They were matched in sex, age, infarct site and coexistent conditions （hypertension, diabetes mellitus, hyperlipemia, smoking etc.）. The second group was further divided into subgroup I with serum peak CK<1000 U/L and subgroup Ⅱ with serum peak CK>1000 U/L. The parameters of platelet function including plasma TXB/6-keto-PGF, platelet aggregation induced by 5-HT and epinephrine were studied on different days for 3 weeks. Twenty healthy persons were selected for normal value of platelet function.展开更多
基金supported by the National Key R&D Program of China(No.2016YFC1301100)National Natural Science Foundation of China(No.81827806,81870353,31771241)Key Laboratory of Myocardial Ischemia,Ministry of Education(No.KF201903)。
文摘BACKGROUND The variability of metabolic biomarkers has been determined to provide incremental prognosis information,but the implications of electrolyte variability remained unclear.METHODS We investigate the relationships between electrolyte fluctuation and outcomes in survivors of acute myocardial infarction(n=4386).Ion variability was calculated as the coefficient of variation,standard deviation,variability independent of the mean(VIM)and range.Hazard ratios(HR)were estimated using the multivariable-adjusted Cox proportional regression method.RESULTS During a median follow-up of 12 months,161(3.7%)patients died,and heart failure occurred in 550(12.5%)participants after discharge,respectively.Compared with the bottom quartile,the highest quartile potassium VIM was associated with increased risks of all-cause mortality(HR=2.35,95%CI:1.36–4.06)and heart failure(HR=1.32,95%CI:1.01–1.72)independent of cardiac troponin I(c Tn I),N terminal pro B type natriuretic peptide(NT-pro BNP),infarction site,mean potassium and other traditional factors,while those associations across sodium VIM quartiles were insignificant.Similar trend remains across the strata of variability by other three indices.These associations were consistent after excluding patients with any extreme electrolyte value and diuretic use.CONCLUSIONS Higher potassium variability but not sodium variability was associated with adverse outcomes post-infarction.Our findings highlight that potassium variability remains a robust risk factor for mortality regardless of clinical dysnatraemia and dyskalaemia.
文摘Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient <span>by physical and noninvasive diagnostic tests, he was diagnosed as a case of</span> acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in <span>ER and then shifted to Cardiology Department for monitoring and further</span> <span>coronary evaluation by coronary angiography (CAG). CAG revealed essen</span><span>tially single vessel disease (SVD) with complex left anterior descending (LAD) </span>artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left <i>in vivo</i>. Immediate decision making and <span>surgical management for retrieval of lost angioplasty device and correction</span> coronary lesion with revascularization save the patient from grave complica<span>tion. All the series of events and management approaches of this very com</span>plex coronary artery lesion are discussed in this article.
文摘The best time of stem cells transplantation for treating acute myocardial infarction (AMI) is still to be followed with interest and a focus issue for clinical cardiologist. A brief meta-analysis of clinical trials about timing-window and therapeutic effects of stem cell transplantation for treating AMI will be made out in this article.
文摘SCAD （spontaneous coronary artery dissection） proves to be a pathology of several manifestations, whose clinical diagnosis is a challenge for emergency departments. Therefore, their early identification and knowledge of the various forms of presentation are mandatory for optimal medical therapy. We present a case report of a 45-year-old patient who was admitted to the coronary unit showing symptoms and laboratory tests compatible with myocardial infarction. Complete diagnosis was obtained only with more specific exams. The manifestations of the disease in the case described and the main features of the disease are discussed.
文摘Objectives Bone-marrow stem-cell transplantation has been shown to improve cardiac function in patients with acute myocardial infarction (AMI) , but the safety of intracoronory infusion of autologous peripheral blood stem-cell (PBSCs) in patients with AMI is unknown. For this reason, we observe the feasibility and safety of PBSCs transplantation by intracoronory infusion in such patients. Methods 41 patients with AMI were allocated to receive granulocyte colony-stimulating factor (G- CSF: Filgrastim,300μg) with the dose of 300μg~ 600μg/day to mobilize the stem cell, and the duration of applying G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cel 1 separator into suspend liquid 57 ml. Then the suspend liquid was infused into the infarct related artery (IRA) by occluding the over the wire balloon and infusing artery through balloon center lumen. In the process of the intracoronary infusion of PBSCs, the complications should be observed, which were arrhythmias including of bradycardia, sinus arrest or atrial ventricular block, premature ve. ntricular beats ,ven~icular tachycardia, ventricular fibrillation; and hypotention, etc. Results There were total 10 cases with complications during the intracoronary infusion of PBSCs. The incidence of complications was 24.4% (10/41), including bradyca- rdia was 2.4 % (1/41), sinus arrest or atrial ventri- cular block was 4.0% (2/41), ventricular fibrillation was 2.4 % (1/41), hypotention was 14.6 % (6/41). Conclusions In patients with AMI, intracoronary infusion of PBSCs is feasible and safe.
文摘Objective: The beneficial effect of percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) has been well established, but there is the problem of no-reflow phenomenon which is an adverse prognostic factor in primary PCI. In the present study the effect of a distal protection device (PercuSurge GuardWire; GW) on epicardial blood flow and myocardial perfusion was evaluated. Methods and Results: Patients with AMI were randomly divided into 2 groups, the GW and the control groups. The GW group included 52 patients with AMI who underwent primary PCI with GW protection and the control group included 60 patients who underwent primary PCI without GW protection. Epicardial blood flow in the infarct-related artery (IRA) and myocardial perfusion were evaluated according to the thrombolysis in myocardial infarction (TIMI) flow grade and the myocardial blush grade (MBG). We found TIMI score of 3 was obtained significantly more frequently in the GW group (96%) than in the control group (80%). The MBG score of 3 was obtained also significantly greater in the GW group (65%) than in the control group (33%). Conclusion: Primary PCI with GW protection can significantly improve epicardial blood flow and myocardial perfusion.
文摘To assess the optimal dose of aspirin （ASA） in the treatment of AMI, 60 cases of AMI: 1. admitted within 24 hours after onset of illness, 2. ASA not used within one week before, 3. any other drugs influencing the platelet function also not used during the course of study, were randomized into two groups, 30 cases each: one with conventional therapy as control, the other combined with daily oral ASA 100mg. They were matched in sex, age, infarct site and coexistent conditions （hypertension, diabetes mellitus, hyperlipemia, smoking etc.）. The second group was further divided into subgroup I with serum peak CK<1000 U/L and subgroup Ⅱ with serum peak CK>1000 U/L. The parameters of platelet function including plasma TXB/6-keto-PGF, platelet aggregation induced by 5-HT and epinephrine were studied on different days for 3 weeks. Twenty healthy persons were selected for normal value of platelet function.
