Comparative Study of Acute Coronary Syndrome with Persistent ST-Segment Elevation (STEMI) between Diabetics and Non-Diabetics in Dakar, Senegal

Introduction: This study aimed to compare the frequency of diabetic and non-diabetic patients admitted for ST-elevation myocardial infarction (STEMI), assess their epidemiological, clinical, and paraclinical profiles, and evaluate their therapeutic strategies and outcomes. Methodology: A descriptive, analytical, comparative study with prospective and retrospective data collection was conducted from April 1, 2020, to March 31, 2021. Diabetic and non-diabetic patients with STEMI admitted to a cardiology department were included. STEMI diagnosis was based on clinical and electrocardiographic criteria showing persistent ST-segment elevation in at least two leads. All patients included in the study signed a written, informed consent form. Data analysis was performed using SPSS, with a p-value ≤ 0.05 considered statistically significant. Results: STEMI prevalence was 15.27%, with 37.11% of patients being diabetic and 62.89% non-diabetic. Diabetic patients had a mean age of 59.2 ± 10.9 years, while non-diabetics averaged 58 ± 13.4 years. Diabetics were predominantly female (72.2%), whereas non-diabetics were mainly male (83.6%). Smoking was less frequent among diabetics (25% vs. 47.54%), but hypertension, obesity, and sedentary lifestyle were more common. Diabetics had an average of 3.5 ± 1.1 risk factors compared to 2.6 ± 1.2 in non-diabetics. Admission delay was longer for diabetics (34.8 ± 51.6 hours vs. 23.3 ± 52.3 hours). Chest pain was the main symptom in both groups. Electrocardiograms showed that anterior and inferior infarctions were most frequent. Triple vessel disease and severe complications, such as cardiogenic shock, were more common in diabetics, who also had higher mortality (5.56% vs. 3.28%). Conclusion: Diabetic STEMI patients represent a high-risk group with distinct clinical features, longer admission delays, and a greater accumulation of cardiovascular risk factors, emphasizing the need for targeted interventions.

Value of GRACE and SYNTAX scores for predicting the prognosis of patients with non-ST elevation acute coronary syndrome

BACKGROUND GRACE and SYNTAX scores are important tools to assess prognosis in non-STelevation acute coronary syndrome(NSTE-ACS).However,there have been few studies on their value in patients receiving different types of therapies.AIM To explore the value of GRACE and SYNTAX scores in predicting the prognosis of patients with NSTE-ACS receiving different types of therapies.METHODS The data of 386 patients with NSTE-ACS were retrospectively analyzed and categorized into different groups.A total of 195 patients who received agents alone comprised the medication group,156 who received medical therapy combined with stents comprised the stent group,and 35 patients who were given agents and underwent coronary artery bypass grafting(CABG)comprised the CABG group.General information was compared among the three groups.GRACE and SYNTAX scores were calculated.The association between the relationship between GRACE and SYNTAX scores and the occurrence of major adverse cardiovascular events(MACEs)was analyzed.Pearson’s correlation analysis was used to determine the factors influencing prognosis in patients with NSTE-ACS.Univariate and multivariate analyses were conducted to analyze the predictive value of GRACE and SYNTAX scores for predicting prognosis in patients with NSTE-ACS using the Cox proportional-hazards model.RESULTS The incidence of MACE increased with the elevation of GRACE and SYNTAX scores(all P<0.05).The incidence of MACE was 18.5%,36.5%,and 42.9%in the medication group,stent group,and CABG group,respectively.By comparison,the incidence of MACE was significantly lower in the medication group than in the stent and CABG groups(all P<0.05).The incidence of MACE was 6.2%,28.0%and 40.0%in patients with a low GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 31.0%,30.3%and 42.9%in patients with a medium GRACE score in the medication group,stent group,and CABG group,respectively(P>0.05).The incidence of MACE was 16.9%,46.2%,and 43.8%in patients with a high GRACE score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 16.2%,35.4%and 60.0%in patients with a low SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).The incidence of MACE was 37.5%,40.9%,and 41.7%in patients with a medium SYNTAX score in the medication group,stent group,and CABG group,respectively(P>0.05).MACE incidence was 50.0%,75.0%,and 25.0%in patients with a high SYNTAX score in the medication group,stent group,and CABG group,respectively(P<0.05).Univariate Cox regression analyses showed that both GRACE score(hazard ratio[HR]=1.212,95%confidence interval[CI]:1.083 to 1.176;P<0.05)and SYNTAX score(HR=1.160,95%CI:1.104 to 1.192;P<0.05)were factors influencing MACE(all P<0.05).Multivariate Cox regression analyses showed that GRACE(HR=1.091,95%CI:1.015 to 1.037;P<0.05)and SYNTAX scores(HR=1.031,95%CI:1.076 to 1.143;P<0.05)were independent predictors of MACE(all P<0.05).CONCLUSION GRACE and SYNTAX scores are of great value for evaluating the prognosis of NSTE-ACS patients,and prevention and early intervention strategies should be used in clinical practice targeting different risk scores.

Effects of omeprazole or pantoprazole on platelet function in non-ST-segment elevation acute coronary syndrome patients receiving clopidogrel

Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.

N-Terminal Pro-BNP in Acute Coronary Syndrome Patients with ST Elevation versus Non ST Elevation Myocardial Infarction

The study aimed to evaluate the differences in secretion of NT-proBNP and conventional cardiac markers in patients with STE-ACS vs NSTE-ACS as a trial to solve the dilemma of the early detection of myocardial ischemia in NSTE-ACS. Sixty two patients with acute coronary syndrome (ACS) divided into 2 groups according to ECG: group1 with elevated ST segment in ECG (STE-ACS) and group 2 with non elevated ST segment (NSTE-ACS).Twenty healthy subjects with matched age and sex were enrolled as control group in this study. In the sera of all subjects, levels of NT –proBNP, CK-MB and troponin-T were measured by different kits. CK-MB and TnT were both significantly higher in STE-ACS patients compared to NSTE-ACS patients. Conversely, NT-proBNP was significantly higher in NSTE-ACS patients than STE-ACS especially within 4 hours from onset of chest pain. Comparison between NT-proBNP, TnT and CK-MB levels by ROC curves revealed area under the curves = 0.68, 0.31, 0.17 respectively. NT-proBNP at cutoff 415 pg/mL in NSTE-ACS patients had higher sensitivity and specificity (92%, 39%;respectively) than other markers that will help in earl diagnosis of NSTE-ACS.

Impact of invasive treatment strategy on health-related quality of life six months after non-ST-elevation acute coronary syndrome

BackgroundFew studies have compared change in the health-related quality of life （HRQL） following treatment of non-ST-elevation acute coronary syndrome （NSTE-ACS） with either percutaneous coronary intervention （PCI） or coronary artery bypass grafting （CABG）. This study is tocompare changes in HRQL six months after hospital discharge between NSTE-ACS pa-tients who underwent either PCI or CABG.Methods HRQL was assessed using the Seattle angina questionnaire at admission and six months after discharge in 1012 consecutive patients with NSTE-ACS. To assess associations of PCI and CABG with HRQL changes, logistic regression models were constructed treating changes in the score of each dimension of the Seattle angina question-naire as dependent variables.Results Although both the PCI and CABG groups experienced angina relief and other improvements at 6-month follow-up （P〈0.001）, the CABG relative to PCI group showed more significant improvements in angina frequency （P= 0.044） and quality of life （P= 0.028）. In multivariable logistic analysis, CABG also was an independent predictor for both im-provement of angina frequency （OR： 1.62, 95%CI： 1.09-4.63,P= 0.042） and quality of life （OR： 2.04, 95%CI： 1.26-6.92,P= 0.038） relative to PCI.Conclusions In patients with NSTE-ACS, both PCI and CABG provide great improvement in disease-specific health status at six months, with that of CABG being more prominent in terms of angina frequency and quality of life.

Acute Coronary Syndrome with Persistent ST Segment Elevation Isolated in aVR: A Case Study

A 53 years old female patient with hypertension presented with constrictive retrosternal chest pain. Initial Electrocardiogram (ECG) showed ST elevation in aVR and high level cardiac Troponin-I. Thrombolysis with streptokinase was performed and she underwent?coronary angiography who showed a long tight anterior inter ventricular lesion, occlusion of the proximal circumflex and an intermediate lesion of segment 2 of the right coronary.

Significance of lead aVR in acute coronary syndrome

The 12-lead electrocardiogram(ECG)is a crucial tool in the diagnosis and risk stratification of acute coronary syndrome(ACS).Unlike other 11 leads,lead aVR has been long neglected until recent years.However,recent investigations have shown that an analysis of ST-segment shift in lead aVR provides useful information on the coronary angiographic anatomy and risk stratification in ACS.ST-segment elevation in lead aVR can be caused by(1)transmural ischemia in the basal part of the interventricular septum caused by impaired coronary blood flow of the first major branch originating from the left anterior descending coronary artery;(2)transmural ischemia in the right ventricular outflow tract caused by impaired coronary blood flow of the large conal branch originating from the right coronary artery;and(3)reciprocal changes opposite to ischemic or non-ischemic ST-segment depression in the lateral limb and precordial leads.On the other hand,ST-segment depression in lead aVR can be caused by transmural ischemia in the inferolateral and apical regions.It has been recently shown that an analysis of T wave in lead aVR also provides useful prognostic information in the general population and patients with prior myocardial infarction.Cardiologists should pay more attention to the tracing of lead aVR when interpreting the12-lead ECG in clinical practice.

Percutaneous treatment in acute coronary syndromes

Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharma- cological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations.

Non-HDL-C和RLP-C与急性ST段抬高型心肌梗死行急诊PCI住院期间不良心脏事件的相关性研究

目的 探讨非高密度脂蛋白胆固醇(non-HDL-C)和残粒脂蛋白胆固醇(RLP-C)与急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)住院期间发生不良心脏事件的相关性。方法 回顾性选取2017年1月~2018年6月在安徽省立医院就诊并接受急诊PCI手术的STEMI患者400例(入院前1个月内均无他汀类药物的持续服用史),根据患者住院期间是否发生主要不良心脏事件(MACE),将其分为MACE组(32例)和良好组(368例)。对所有患者进行血脂检测,并计算其non-HDL-C和RLP-C值。比较MACE组与良好组之间的non-HDL-C和RLP-C值差异,并通过多因素logistic回归分析non-HDL-C和RLP-C与STEMI患者行急诊PCI手术住院期间发生MACE的相关性。结果 与良好组相比,MACE组患者的non-HDL-C和RLP-C值均显著升高,差异有统计学意义(P<0.01)。多因素logistic回归分析表明,non-HDL-C和RLP-C值是STEMI患者发生院内MACE的独立预测因素(OR=1.728,1.672;P<0.01)。结论 non-HDL-C和RLP-C水平与STEMI行急诊PCI手术住院期间MACE的发生情况密切相关,积极控制non-HDL-C和RLP-C可能有助于防止急性心肌梗死的发生,检测non-HDL-C和RLP-C值可能有助于STEMI早期风险的评估。

地中海饮食模式和急性非ST段抬高型心肌梗死发生风险的关系研究

目的探讨地中海饮食模式与急性非ST段抬高型心肌梗死(NSTEMI)发生风险的相关性。方法本研究是一项单中心大型病例对照研究。收集2017年1月至2020年12月在首都医科大学附属北京安贞医院首次确诊为急性NSTEMI的患者600例作为急性NSTEMI组。根据年龄、性别进行1∶1匹配选取同期本院体检中心健康体检者600人作为对照组。比较2组一般资料。根据饮食频率调查问卷计算出改良地中海饮食评分(AMEDS)。将所有受试者按AMEDS分为AMEDS<4分组、AMEDS 4~5分组和AMEDS≥6分组。分析总体及不同AMEDS组的急性NSTEMI发生风险,分析AMEDS中不同种类食物与急性NSTEMI发生风险的相关性。结果急性NSTEMI组有高血压病、糖尿病病史的患者比例、收缩压、体重指数、目前吸烟者比例均高于对照组,家庭收入≥120000元/年的比例、AMEDS均低于对照组,差异均有统计学意义(均P<0.05)。相对于AMEDS<4分组的受试者而言,AMEDS 4~5分组以及AMEDS≥6分组受试者急性NSTEMI发生风险明显降低(调整年龄、性别、受教育年限、家庭年收入、病史、体重指数、血压、血红蛋白、生活方式等多个协变量后的多因素分析比值比=0.72,95%置信区间:0.53~0.94,P=0.031;比值比=0.62,95%置信区间:0.47~0.84,P=0.008)。将患者按年龄和性别进行分层,多因素回归分析后发现,随AMEDS增加,急性NSTEMI发生风险降低的趋势在男性和年龄<60岁的人群依然存在(均P<0.05),在女性和≥60岁的人群中,趋势差异无统计学意义(均P>0.05),同时分层之间交互性分析后差异均无统计学意义(均P>0.05)。AMEDS食物种类分析结果显示,蔬菜、鱼类降低急性NSTEMI发生风险,红肉或加工肉类增加其发生风险(比值比=0.51,95%置信区间:0.42~0.66,P<0.001;比值比=0.75,95%置信区间:0.59~0.94,P=0.010;比值比=1.51,95%置信区间:1.21~1.90,P<0.001)。结论地中海饮食模式和急性NSTEMI的发生相关,改良地中海饮食的高依从性可能降低急性NSTEMI的发生风险。

三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后心肌灌注及短期预后的影响

目的探讨三种冠状动脉内灌注用药方案对高血栓负荷急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入(PCI)术后心肌灌注及短期预后的影响。方法前瞻性、单中心、随机对照研究。纳入2017年3月至2021年8月焦作市人民医院心内科高血栓负荷STEMI患者150例,按照分层区组随机化原则等分为三组各50例。A组:尼可地尔+替罗非班靶血管灌注;B组:尿激酶原+替罗非班靶血管灌注;C组:尼可地尔+尿激酶原+替罗非班靶血管灌注。于PCI术前、术后即刻检测记录梗死相关动脉(IRA)的心肌梗死溶栓试验(TIMI)血流分级、TIMI心肌灌注分级(TMPG)、校正的TIMI血流帧数(CTFC);于PCI术前、术后24 h记录心电图的ST段回落幅度;记录IRA开通后24 h内Curtis-Walker评分及恶性心律失常例数;于PCI术前、术后0 h、12 h、24 h、3 d及7 d检测血清高敏肌钙蛋白I(hs-cTnI);于PCI术前、术后24 h及7 d检测丙二醛(MDA)、超氧化物歧化酶(SOD);于PCI术前、术后7 d、术后1个月、术后6个月及术后12个月检测左心室射血分数(LVEF)。随访记录患者住院期间及出院后30 d内的出血事件及术后12个月内主要不良心血管事件(MACE)。结果(1)PCI术后即刻,C组患者的TIMI血流分级、TMPG均优于A组(Z=-16.610,P=0.023;Z=-18.400,P=0.015)和B组(Z=-15.130,P=0.046;Z=16.550,P=0.035);C组患者的CTFC帧数低于A组(P<0.001)和B组(P=0.001)。(2)PCI术后,C组患者的血清hs-cTnI水平低于A组和B组(均为P<0.001)。(3)PCI术后,C组患者的MDA水平低于A组和B组(均为P<0.001),SOD水平高于A组(P=0.004)和B组(P=0.024)。(4)PCI术后24 h,C组患者的ST段回落幅度大于A组(P=0.003)和B组(P=0.012),Curtis-Walker评分及恶性心律失常发生率低于A组(P=0.008、0.015)和B组(P=0.014、0.034)。(5)PCI术后,C组患者的LVEF水平高于A组和B组(均为P<0.001)。(6)住院期间及出院后30 d内,三组患者均未发生大出血,少量出血和微量出血的发生率比较无统计学差异(χ^(2)=1.385,P=0.500);术后12个月内,C组患者的MACE发生率低于A组和B组(χ^(2)=7.400,P=0.025)。结论尼可地尔+尿激酶原+替罗非班靶血管灌注具有协同作用,可有效改善STEMI患者PCI术后的心肌灌注,减轻术后心肌损伤和氧化应激损伤,促进ST段回落,降低恶性心律失常发生率,有效促进心功能恢复,减少心血管不良事件,且不增加术后出血。

老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后延长应用替格瑞洛对临床转归的影响

目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的≥65岁急性STEMI患者105例(应用DAPT评分系统评估均≥2分),在阿司匹林长期用药基础上,根据患者服用替格瑞洛时间不同分为对照组(n=37,使用时间为PCI治疗后1年)与观察组(n=68,在对照组基础上再延长替格瑞洛治疗1年),其中观察组根据延长应用替格瑞洛的剂量不同又分为2个亚组,即观察A组(n=40,标准剂量,90 mg/次,每日2次)和观察B组(n=28,小剂量,45 mg/次,每日2次)。比较3组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、心电图完全回落比例、血栓弹力图中的血小板功能(MA)、二磷酸腺苷诱导的血小板聚集率;随访1年,主要不良心脑血管事件(MACCE)、出血事件发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较采用t检验、χ^(2)检验。结果PCI术后,观察A、B组的TIMI 3级血流患者比例显著高于对照组(χ^(2)=4.699、4.353;P=0.030、0.036),而观察A组与观察B组组间差异无统计学意义。PCI治疗后2年,观察A、B组血栓弹力图中的MA值、二磷酸腺苷诱导的血小板聚集率明显低于对照组(t=8.752、6.524;均P<0.001),但观察A组、观察B组比较差异无统计学意义。随访1年,3组总MACCE发生率比较差异有统计学意义(χ^(2)=4.354;P=0.039),其中观察组A、B组MACCE发生率均显著低于对照组(χ^(2)=4.769、5.082;P=0.028、0.024),但观察A组与观察B组间差异无统计学意义;3组患者出血事件发生率差异均无统计学意义。结论老年(≥65岁)STEMI患者(DAPT评分≥2分)PCI后延长应用替格瑞洛可能降低主要不良心脑血管事件发生率,且小剂量(45mg/次)替格瑞洛并未增加出血发生的风险,仍需长期随访观察进一步证实。

不同剂量他汀类药物对经皮冠状动脉介入治疗的老年ST段抬高型急性心肌梗死患者的影响

目的 探讨不同剂量阿托伐他汀、瑞舒伐他汀、辛伐他汀对接受经皮冠状动脉介入治疗(PCI)的老年ST段抬高型急性心肌梗死(STEMI)患者的影响。方法 前瞻性选取接受PCI的180例STEMI患者作为研究对象,采用随机数字表法分为A组、B组、C组、D组、E组、F组,每组30例。A组口服低剂量辛伐他汀,B组口服高剂量辛伐他汀,C组口服低剂量阿托伐他汀,D组口服高剂量阿托伐他汀,E组口服低剂量瑞舒伐他汀,F组口服高剂量瑞舒伐他汀。比较各组患者血清炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、N末端脑钠肽前体(NT-proBNP)]、心功能指标[左心室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]水平、ST段回落情况及不良心血管事件、不良反应发生情况。结果 术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的IL-6、hs-CRP、TNF-α水平均依次降低,差异有统计学意义(P<0.05);术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的cTnT、CK-MB、NT-proBNP水平均依次降低,差异有统计学意义(P<0.05);术后1个月时,A组、B组、C组、D组、E组、F组的LVEF、CO、CI均依次升高,差异有统计学意义(P<0.05);A组、B组、C组、D组、E组、F组的ST段回落者占比依次升高,差异有统计学意义(P<0.05);各组患者不良心血管事件总发生率、不良反应总发生率比较,差异均无统计学意义(P>0.05)。结论 低剂量、高剂量的阿托伐他汀、瑞舒伐他汀、辛伐他汀应用于PCI术后STEMI患者,均可有效减轻炎症反应,改善心肌功能,促进ST段回落,其中高剂量瑞舒伐他汀效果最佳。

血管内超声参数联合microRNA-206评估非ST段抬高型急性心肌梗死患者病变严重程度及预后的价值

目的探讨血管内超声(IVUS)参数联合microRNA-206(miR-206)评估非ST段抬高型急性心肌梗死(NSTEAMI)患者病变严重程度及预后的价值。方法选取2019年3月-2021年4月河北北方学院附属第一医院收治的105例NSTEAMI患者,所有患者行经皮冠状动脉介入术(PCI),根据病变严重程度将患者分为单支病变组(55例)、双支病变组(32例)、多支病变组(18例)。对比不同病变程度患者IVUS参数、血清miR-206,分析IVUS参数、血清miR-206与NSTEAMI患者病变严重程度的相关性。随访2年,根据是否发生MACE分为发生组与非发生组。对比发生组与非发生组的临床资料,采用多因素逐步Logistic回归模型分析NSTEAMI患者发生主要不良心脏事件(MACE)的影响因素。绘制受试者工作特征(ROC)曲线,评估IVUS参数、血清miR-206预测NSTEAMI患者发生MACE的效能。结果多支病变组斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于单支、双支组(P<0.05),且双支病变组均高于单支病变组(P<0.05)。Pearson相关性分析结果显示,血管外弹力膜面积与NSTEAMI患者病变严重程度无相关性(r=0.271,P=0.325);斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206与NSTEAMI患者病变严重程度呈正相关(r=0.416、0.382、0.423、0.507和0.394,均P=0.000)。随访2年,失访2例,剩余103例患者中32例(31.07%)发生MACE,71例(68.93%)未发生MACE。发生组多支病变、血运未重建占比、斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于非发生组(P<0.05),淋巴细胞计数、血红蛋白水平均低于非发生组(P<0.05)。多因素逐步Logistic回归分析结果显示:多支病变[OR=3.466(95%CI:1.523,7.884)]、血运未重建[OR=2.776(95%CI:1.220,6.315)]、斑块负荷[OR=3.155(95%CI:1.387,7.177)]、重构指数[OR=3.842(95%CI:1.689,8.740)]、偏心指数[OR=4.166(95%CI:1.831,9.477)]、血清miR-206[OR=4.500(95%CI:1.978,10.236)]为NSTEAMI患者发生MACE的危险因素(P<0.05)。ROC曲线结果显示,斑块负荷、重构指数、偏心指数、血清miR-206四者联合预测NSTEAMI患者发生MACE的敏感性为88.52%(95%CI:0.674,0.957),特异性为92.86%(95%CI:0.713,0.968),曲线下面积为0.900(95%CI:0.812,0.953)。结论IVUS参数(斑块负荷、重构指数、偏心指数)、血清miR-206在评估NSTEAMI患者病变严重程度与预后中具有重要价值,且四者联合具有更高的预测价值。

沙库巴曲缬沙坦用于急性前壁ST段抬高型心肌梗死行急诊PCI术后患者的临床疗效

目的探究沙库巴曲缬沙坦用于急性前壁ST段抬高型心肌梗死(STEMI)行急诊PCI术后患者的临床疗效。方法选取2022年3月—2023年3月齐齐哈尔市第一医院心内科收治急性前壁STEMI行急诊PCI治疗的患者80例作为研究对象,采用随机数字表法分为对照组40例和观察组40例,对照组以常规药物和依那普利治疗,观察组在对照组的基础上给予沙库巴曲缬沙坦钠治疗。治疗1个月后比较2组患者临床疗效,治疗前后血清学指标、左心室功能以及主要心脏不良事件(MACE)发生率、治疗期间的不良反应。结果观察组临床总有效率显著高于对照组(97.50%vs.77.50%,χ^(2)/P=7.314/0.007);与治疗前比较,2组治疗后的N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、高敏C反应蛋白(hs-CRP)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)均下降,左心室射血分数(LVEF)均升高,且观察组各指标降低/升高幅度大于对照组(t/P=5.507/<0.001、11.006/<0.001、5.287/<0.001、4.297/<0.001、6.647/<0.001、2.330/0.022);观察组的MACE发生率低于对照组(5.00%vs.20.00%,χ^(2)/P=4.114/0.043);2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论沙库巴曲缬沙坦用于急性前壁ST段抬高型心肌梗死行急诊PCI术后的患者疗效显著,患者的心功能有所改善,MACE发生率降低,且相对安全。

GRACE、TIMI评分对非ST段抬高型急性冠状动脉综合征患者不良心血管事件的评估价值

目的探讨全球急性冠状动脉事件注册(GRACE)评分、心肌梗死溶栓治疗(TIMI)评分对非ST段抬高型急性冠状动脉综合征(NSTE-ACS)患者不良心血管事件的评估价值。方法回顾性收集2020年1月~2023年11月新疆维吾尔自治区人民医院治疗的257例NSTE-ACS患者的临床资料。根据GRACE和TIMI评分将患者分为低危组、中危组、高危组。统计患者发病30 d内不良心血管事件的发生情况,并对不同风险分层患者不良心血管事件的发生率进行比较,计算受试者工作特征(ROC)曲线的曲线下面积(AUC),评估GRACE、TIMI评分对NSTE-ACS患者不良心血管事件的评估价值。结果TIMI评分系统的低危患者比例为23.35%(60/257),与GRACE评分系统的18.68%(48/257)比较,差异无统计学意义(P>0.05);TIMI评分系统的中危患者比例为62.65%(161/257),高于GRACE评分系统的40.47%(104/257);TIMI评分系统的高危患者比例为14.00%(36/257),低于GRACE评分系统的40.86%(105/257),差异均有统计学意义(t=25.308、48.101,P<0.05)。两种评分系统不同分层患者不良心血管事件总发生率比较,差异有统计学意义(χ^(2)=24.403,P<0.05);死亡率比较,差异无统计学意义(χ^(2)=0.778,P>0.05)。GRACE评分预测NSTE-ACS患者不良心血管事件的AUC为0.756,高于TIMI评分的0.603。结论GRACE和TIMI风险评分对于NSTE-ACS患者近期心血管不良事件的发生均有一定的适用性,GRACE评分的预测价值更高。

NLR与MSI对急性NSTEMI短期预后判断价值

目的本研究旨在探讨校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR)在判断急性非ST段抬高型心肌梗死(NSTEMI)患者短期内可能出现不良预后的预测能力。方法研究组选择2020年3月到2021年9月期间,首次就诊急诊科明确诊断为急性非ST段抬高型心肌梗死的276例患者。通过快速急诊绿道监测血压与心率,并于急诊科10 min内抽取血常规、床旁心脏彩超等相关化验检查,依据监测及化验结果,研究小组计算了校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR),然后根据统计结果将患者分为2组:NLR≥5.0组(n=75)与NLR﹤5.0组(n=201);(2)MSI≥1.2组(n=57)与MSI<1.2组(n=219)。比较2组一般资料情况,发生不良心血管事件的比例,采用受试者ROC曲线下面积来评估NLR值和MSI值对NSTEMI院内不良心血管事件的预测能力。结果连续入选的276例NSTEMI患者中,发生不良心血管事件52例,占18.8%,心源性休克患者15例,占5.4%,恶性心律失常患者24例,占8.7%,死亡13例,占4.7%。NLR≥5.0与MSI≥1.2值组的心功能、收缩压(SBP)、舒张压(DBP)及心率(HR)分别与NLR<5.0与MSI<1.2组比较,差异有统计学意义(P<0.05);NLR≥5.0与MSI≥1.2组MACE发生率分别高于NLR<5.0组与MSI<1.2组(P<0.05)。此外,NLR和MSI的ROC曲线下面积分别为0.734和0.703,提示NLR和MSI均具有评价急性非ST段抬高型心肌梗死患者短期不良心血管事件发生能力。结论MSI与NLR是评估NSTEMI短期不良预后的两个简单的重要的易获得指标。

急诊经皮冠状动脉介入术联合体外肺膜氧合成功救治急性ST段抬高型心肌梗死1例报道

急性ST段抬高型心肌梗死(STEMI)是冠心病的严重类型之一,通过介入手段早期快速开通梗死相关动脉是改善预后的关键,部分急性STEMI患者易出现心源性休克,导致介入治疗无法实施。体外膜肺氧合(ECMO)技术通过呼吸和循环功能支持,使介入治疗的安全性和有效性得以提高。本文报告通过急诊经皮冠状动脉介入术联合ECMO成功救治1例STEMI患者的过程,并讨论如何提高急性STEMI尤其是合并心源性休克患者的救治成功率。

超声联合血清AnxA1、MMP-3对NSTE-ACS患者PCI术后冠状动脉再狭窄的预测价值

目的探讨血清膜联蛋白A1(AnxA1)、基质金属蛋白酶-3(MMP-3)联合冠状动脉血管内超声钙化特征对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者经皮冠状动脉介入治疗(PCI)术后冠状动脉再狭窄的预测价值。方法回顾性选取2019年7月至2022年5月鄂州市中心医院行PCI治疗的236例NSTE-ACS患者为研究对象,依据随访1年内冠状动脉再狭窄情况分为再狭窄组(n=24)和非狭窄组(n=212)。收集患者临床资料,对比患者血清AnxA1、MMP-3水平、血管内超声检查结果;采用Logistic多因素回归分析NSTE-ACS患者PCI术后冠状动脉再狭窄影响因素;受试者操作特征(ROC)曲线分析血清AnxA1、MMP-3水平联合钙化特征评分预测术后冠状动脉再狭窄的价值。结果再狭窄组血清AnxA1、MMP-3水平及钙化病变比例、浅表型钙化比例、钙化弧度、钙化长度、钙化特征评分分别为(2.40±0.61)μg/L、(56.49±12.31)μg/L、66.67%、70.83%、(162.18±28.43)°、(25.91±4.56)mm、(5.02±1.28)分,高于非狭窄组[(1.78±0.40)μg/L、(42.78±10.07)μg/L、22.64%、29.72%、(78.41±20.39)°、(13.72±3.68)mm、(3.47±1.02)分],差异均有统计学意义(P<0.05)。AnxA1、MMP-3、钙化特征评分是NSTE-ACS患者PCI术后冠状动脉再狭窄的独立危险因素(P<0.05)。AnxA1、MMP-3、钙化特征评分及3者联合预测NSTE-ACS患者PCI术后冠状动脉再狭窄的AUC分别为0.825、0.780、0.854、0.960。结论AnxA1、MMP-3、钙化特征评分是NSTE-ACS患者PCI术后冠状动脉再狭窄的独立危险因素,3者联合较单一指标对冠状动脉再狭窄的预测价值更高。

药物涂层球囊在老年急性非ST段抬高型心肌梗死患者中的应用价值

目的探讨在老年非ST段抬高型心肌梗死(NSTEMI)患者的犯罪血管中应用药物涂层球囊(DCB)的疗效及安全性。方法纳入2017年2月至2021年6月于厦门大学附属第一医院心血管内科行经皮冠状动脉介入治疗(PCI)的急性NSTEMI老年患者,随机分为药物涂层球囊组(DCB组,n=60)和药物洗脱支架组(DES组,n=62)。比较两组患者的基本临床资料、冠状动脉病变情况、造影剂用量;比较PCI术中、术后12个月随访犯罪血管的管腔变化情况;比较两组随访一年内的主要不良心脏事件(MACE)以及所有的出血情况。结果两组在PCI术中使用的造影剂剂量没有统计学差异(P=0.157),术前两组靶病变的参考管腔直径(RVD)及最小管腔直径(MLD)均无明显统计学差异(P>0.05)。DCB组PCI术后即刻(MLD)[(2.76±0.78)mm vs.(3.18±1.01)mm,P=0.012]及即刻管腔获得(ALG)[(1.90±0.32)mm vs.(2.03±0.26)mm,P=0.015]均比DES组小,二者差异有统计学意义。但DCB组的晚期管腔丢失(LLL)小于DES组[(0.76±1.26)mm vs.(1.31±1.73)mm,t=2.111,P=0.037],二者有统计学差异。两组术后随访12个月内总体MACE事件无统计学差异(P>0.05),DCB组的出血事件显著低于DES组(5.00%vs.17.74%,χ^(2)=4.873,P=0.027),但两组均未发现致命性出血。结论DCB处理老年NSTEMI的靶血管病变,为患者带来良好的安全性及获益,是高危出血风险及脏器功能衰退的老年NSTEMI患者的另一种安全有效的选择。