BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive pa...Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.展开更多
<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEM...<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups</span></span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level <</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05 and the data were tested for significant correlations between two predetermined groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p < 0.05). A ROC curve has identified a level of 127 ng/dL as the best cutoff of Hs-troponin in detecting obstructive CAD (p = 0.03). Interestingly, 60% of patients in group B had alternative diagnoses. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Hs-troponin is sensitive but less specific for obstructive CAD. However</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> increasing its cutoff value will improve its specificity.</span>展开更多
The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST eleva...The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.展开更多
Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for no...Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.展开更多
Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a n...Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.展开更多
BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in pr...BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).展开更多
Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent p...Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.展开更多
Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation...Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.展开更多
Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortali...Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (STEMI) who had preserved renal function at baseline. Methods We enrolled patients with STEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups:< 2.50 mg/dL (n = 89), 2.51–3.50 mg/dL (n = 1066), 3.51–4.50 mg/dL (n = 672) and > 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of < 2.50 mg/dL, 3.51–4.50 mg/dL and > 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with STEMI who had preserved renal function at baseline.展开更多
Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest...Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.展开更多
Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocard...Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P 〈0.01), while CRP levels were not significantly different between patient with STEMI and NSTEMI (3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels展开更多
Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this rela...Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI),and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods:This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients (399 men,114 women) with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R' or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events (MACE) were recorded.Results:In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P =0.042).There were fewer Killip Class Ⅰ patients in the fQRS group (P =0.019),while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group (P =0.019).Left ventricular ejection fraction levels were significantly lower in the fQRS group (P =0.021).Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein (CRP),and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE (MACE,P =0.028),revascularization (P =0.005),and recurrent angina (P =0.005) were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS:Coronary artery narrowing (P =0.035),Killip classification (P =0.026),and total cholesterol (P =0.002).The following variables were found to be independent predictors of preoperative MACE:Hemoglobin (P =0.000),gender (P =0.026),fQRS (P =0.016),and time from myocardial infarction to balloon or coronary artery bypasses grafting (P =0.013).Conclusions:The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.展开更多
Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalizati...Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XST) ...展开更多
Background: In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative stra...Background: In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and characterized the patients selected for an invasive approach. Methods: A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy (586 patients) and invasive strategy (390 patients) group. Unified tbllow-up questionnaire was performed by telephone contact (cut-off date was November, 2013). The long-term clinical events were analyzed and related to the different treatment strategies. Results: The median follow-up time was 29 months. Mortality was 28.7% (n = 168) in the conservative group and 2.1% (n = 8) in the invasive management at long-term clinical follow-up. The secondary endpoint (the composite endpoint) was 59.0% (n = 346) in the conservative group and 30.3% (n = 118) in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management (adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]: 3.796 16.006, P 〈 0.001), and the similar result was also seen in tile secondary endpoint (adjusted RR : 2.102; 95% (7: 1.694-2.610, P 〈 0.001 ). In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score (TRS), log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients (TRS 3-7). Conclusions: An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones (TRS 3- 7).展开更多
Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients wer...Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups: (1) according to the age: age 〈65 years group and age ≥65 years group; (2) according to thrombolysis in myocardial ischemia trial (TIMI) lib risk stratification scoring system: score 〈4 group and ≥4 group; (3) according to serum creatinine (sCr) level: sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction (AMI) patients during the same period were divided into ST segment elevation myocardial infarction (STEMI) group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results (1) The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction (sCr 〉 178 μmol· L^-1 )and triple vessel disease. Fewer patients in this group received coronary artery angiography (CAG), percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). More number of deaths in this group compared with the age 〈 65 years group. (2) The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. (3) Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus (NIDDM), patients with cardiac troponin T (CTnT) 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.(4) STEMI and NSTEMI patients were compared in same time frame as follows: fewer NSTEMI patients and more elderly patients had no chest pain, NID- DM, hypertension, dyslipidemia, left main coronary artery (LMCA) disease while CTnT ≥3.0 ng· ml^- ; fewer patients with aneurysm (30 days) underwent CAG, PCI and CABG treatment. However, there were no significant differences in smokers, patients with less than 50% stenosis in any vessel, 1 - 3 vessel disease, acute left ventricle heart failure, cardiogenic shock, serious arrhythmia and deaths. (5) The multivariate logistic regression analysis showed that death in NSTEMI was directly influenced by malignant arrhythmias with age ≥70 years. Conclusions Patients with NSTEMI were older, had more risk factors and presented more serious vessel disease, therefore, less of them could receive standard treatment. Complications and mortality of patients with NSTEMI were similar to that of patients with STEMI. Thus, NSTEMI is a serious disease with poor prognosis. NSTEMI patients may present with atypical chest pain and electrocardiogram changes, so are easily missed or loss diagnosed.展开更多
Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often pr...Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. Methods: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. Results: Compared with patients with STEMI (N=16,315), those with NSTEMI (N=5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs.71.4%), diaphoresis (48.6% vs.70.0%), radiation pain (26.4% vs.33.8%), and more likely to have chest distress (42.4% vs.38.3%) than STEMI patients (all P<0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval:1.849-2.107). Conclusions: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.展开更多
目的探讨并分析急性非ST段抬高心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)术后血清纤维蛋白原/白蛋白值(FAR)、γ-谷氨酰转肽酶(γ-GGT),N端脑钠肽前体(NT-proBNP)水平对预后的预测价值。方法回顾性分析2020年2月至2023年2月邯郸...目的探讨并分析急性非ST段抬高心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)术后血清纤维蛋白原/白蛋白值(FAR)、γ-谷氨酰转肽酶(γ-GGT),N端脑钠肽前体(NT-proBNP)水平对预后的预测价值。方法回顾性分析2020年2月至2023年2月邯郸市中心医院收治的实施PCI的急性NSTEMI患者93例,根据术后30 d主要不良心血管事件(MACE)发生情况将其分为MACE组(n=21)及无MACE组(n=72)。比较术前、术后30 d MACE组及无MACE组血清FAR、γ-GGT、NT-proBNP水平,采用单因素和多因素Logistic回归分析对影响急性NSTEMI患者术后30 d MACE发生的危险因素进行分析,采用受试者操作特征(ROC)曲线分析血清FAR、γ-GGT、NT-proBNP水平对急性NSTEMI患者术后MACE发生的预测价值。结果MACE组年龄为(65.37±3.46)岁;Killip分级为Ⅰ级2例,Ⅱ级3例,Ⅲ级5例,Ⅳ级11例;病变支数双支5例,3支16例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.87±0.55)%、(53.27±3.06)U/L、(914.35±84.35)ng/mL。无MACE组的年龄为(58.71±2.86)岁;Killip分级为Ⅰ级32例,Ⅱ级27例,Ⅲ级7例,Ⅳ级6例;病变支数为双支53例,3支19例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.12±0.51)%、(44.33±3.35)U/L、(656.82±75.63)ng/mL。MACE组和无MACE组的年龄、Killip分级、病变支数及术后30 d血清FAR、γ-GGT、NT-proBNP水平比较,差异均有统计学意义(P<0.05),两组性别、吸烟史、高血压史、高血脂史、糖尿病史及术前1 d血清FAR、γ-GGT、NT-proBNP水平比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,血清FAR、γ-GGT、NT-proBNP升高均为影响急性期NSTEMI患者术后MACE发生的独立危险因素(OR=3.074、2.686、3.340,P均<0.05)。ROC结果显示血清FAR、γ-GGT、NT-proBNP及其联合检测预测急性NSTEMI患者术后MACE发生的曲线下面积(AUC)分别为0.681、0.690、0.733和0.790,联合检测的AUC更高(P<0.05)。结论血清FAR、γ-GGT、NT-proBNP水平升高增加了急性NSTEMI患者PCI术后MACE的发生风险,三者联合检测对患者术后不良预后有一定预测价值。展开更多
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
文摘Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
文摘<strong>Background: </strong><span style="font-family:;" "=""><span style="font-family:Verdana;">The diagnosis of Non-ST Elevated Myocardial Infarction (NSTEMI) is dependent on elevation of high sensitivity troponin (Hs-troponin). The current cutoff point for Hs-troponin is highly sensitive but not specific for obstructive coronary artery disease (CAD). This study aims to determine the best cutoff point for diagnosing CAD in patients presented with NSTEMI. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">Our study included all patients admitted as NSTEMI that underwent coronary angiography (CAG). They were grouped into two groups</span></span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> A and B. Group A has obstructive CAD of 70% or more stenosis and group B with non-obstructive CAD. Patients were assessed for their demographics, clinical history, laboratory and imaging results. Using SPSS version 22, the pooled cohort of patients were analyzed at significant level <</span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.05 and the data were tested for significant correlations between two predetermined groups. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Group A comprised 87.6% of the patients and both groups had a median age of 53 years. In Group A, 91% were males, 54% diabetics, 54% hypertensives, and median Hs-troponin was 145 ng/L. While in group B, 88% were males, 39% diabetics, 60% hypertensives, and median Hs-troponin was 54 ng/L. There was significant correlation between the two groups in the percentage of diabetes and median troponin level (p < 0.05). A ROC curve has identified a level of 127 ng/dL as the best cutoff of Hs-troponin in detecting obstructive CAD (p = 0.03). Interestingly, 60% of patients in group B had alternative diagnoses. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">Hs-troponin is sensitive but less specific for obstructive CAD. However</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> increasing its cutoff value will improve its specificity.</span>
基金Supported by John S Dunn Chair in Cardiology Research and Education
文摘The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.
文摘Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.
基金funded by the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program (No.2011BAI11B05)Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2019_014226_000023)
文摘Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.
基金funded by grants from National Natural Science Foundation of China(81100141 and 81570322 for JJ,81320108003 for JW)jointly supported by Boston Scientific
文摘BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).
文摘Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.
基金supported by the Beijing Tsinghua Changgung Hospital Fund(grant No.12019C1009).
文摘Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.
文摘Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (STEMI) who had preserved renal function at baseline. Methods We enrolled patients with STEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups:< 2.50 mg/dL (n = 89), 2.51–3.50 mg/dL (n = 1066), 3.51–4.50 mg/dL (n = 672) and > 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of < 2.50 mg/dL, 3.51–4.50 mg/dL and > 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with STEMI who had preserved renal function at baseline.
文摘Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 10<sup>9</sup>/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.
文摘Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P 〈0.01), while CRP levels were not significantly different between patient with STEMI and NSTEMI (3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels
文摘Background:There remains significant debate as to the relationship between fragmented QRS (fQRS) complexes on electrocardiogram (ECG) and acute myocardial infarction (AMI).Few studies have reported on this relationship in non-ST elevated AMI (NSTEMI),and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods:This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients (399 men,114 women) with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R' or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events (MACE) were recorded.Results:In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group (P =0.042).There were fewer Killip Class Ⅰ patients in the fQRS group (P =0.019),while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group (P =0.019).Left ventricular ejection fraction levels were significantly lower in the fQRS group (P =0.021).Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein (CRP),and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE (MACE,P =0.028),revascularization (P =0.005),and recurrent angina (P =0.005) were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS:Coronary artery narrowing (P =0.035),Killip classification (P =0.026),and total cholesterol (P =0.002).The following variables were found to be independent predictors of preoperative MACE:Hemoglobin (P =0.000),gender (P =0.026),fQRS (P =0.016),and time from myocardial infarction to balloon or coronary artery bypasses grafting (P =0.013).Conclusions:The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.
文摘Objective:To explore the cardiac protective effect of integrative therapy in acute myocardial infarction(AMI) with elevated ST segment after reperfusion.Methods:Sixty-four AMI patients who having received decimalization by thrombolysis were assigned to two groups by retrospective analysis,36 patients in the treated group and 28 in the control group.Both were treated by intravenous administering of urokinase for thrombolysis,and to the treated group,intravenous dripping of Xueshuantong Injection(血栓通注射液,XST) ...
文摘Background: In cardiology, it is controversial whether different therapy strategies influence prognosis after acute coronary syndrome. We examined and compared the long-term outcomes of invasive and conservative strategies in patients with non-ST-segment elevation myocardial infarction (NSTEMI) and characterized the patients selected for an invasive approach. Methods: A total of 976 patients with acute NSTEMI were collected from December 2006 to October 2012 in the First Affiliated Hospital of Dalian Medical University Hospital. They are divided into conservative strategy (586 patients) and invasive strategy (390 patients) group. Unified tbllow-up questionnaire was performed by telephone contact (cut-off date was November, 2013). The long-term clinical events were analyzed and related to the different treatment strategies. Results: The median follow-up time was 29 months. Mortality was 28.7% (n = 168) in the conservative group and 2.1% (n = 8) in the invasive management at long-term clinical follow-up. The secondary endpoint (the composite endpoint) was 59.0% (n = 346) in the conservative group and 30.3% (n = 118) in the invasive management. Multivariate analysis showed that patients in the conservative group had higher all-cause mortality rates than those who had the invasive management (adjusted risk ratio [RR] = 7.795; 95% confidence interval [CI]: 3.796 16.006, P 〈 0.001), and the similar result was also seen in tile secondary endpoint (adjusted RR : 2.102; 95% (7: 1.694-2.610, P 〈 0.001 ). In the subgroup analysis according to each Thrombolysis in Myocardial Infarction risk score (TRS), log-rank analysis showed lower mortality and secondary endpoint rates in the invasive group with the intermediate and high-risk patients (TRS 3-7). Conclusions: An invasive strategy could improve long-term outcomes for NSTEMI patients, especially for intermediate and high-risk ones (TRS 3- 7).
文摘Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction (NSTEMI). Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups: (1) according to the age: age 〈65 years group and age ≥65 years group; (2) according to thrombolysis in myocardial ischemia trial (TIMI) lib risk stratification scoring system: score 〈4 group and ≥4 group; (3) according to serum creatinine (sCr) level: sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction (AMI) patients during the same period were divided into ST segment elevation myocardial infarction (STEMI) group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results (1) The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction (sCr 〉 178 μmol· L^-1 )and triple vessel disease. Fewer patients in this group received coronary artery angiography (CAG), percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). More number of deaths in this group compared with the age 〈 65 years group. (2) The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. (3) Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus (NIDDM), patients with cardiac troponin T (CTnT) 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.(4) STEMI and NSTEMI patients were compared in same time frame as follows: fewer NSTEMI patients and more elderly patients had no chest pain, NID- DM, hypertension, dyslipidemia, left main coronary artery (LMCA) disease while CTnT ≥3.0 ng· ml^- ; fewer patients with aneurysm (30 days) underwent CAG, PCI and CABG treatment. However, there were no significant differences in smokers, patients with less than 50% stenosis in any vessel, 1 - 3 vessel disease, acute left ventricle heart failure, cardiogenic shock, serious arrhythmia and deaths. (5) The multivariate logistic regression analysis showed that death in NSTEMI was directly influenced by malignant arrhythmias with age ≥70 years. Conclusions Patients with NSTEMI were older, had more risk factors and presented more serious vessel disease, therefore, less of them could receive standard treatment. Complications and mortality of patients with NSTEMI were similar to that of patients with STEMI. Thus, NSTEMI is a serious disease with poor prognosis. NSTEMI patients may present with atypical chest pain and electrocardiogram changes, so are easily missed or loss diagnosed.
文摘Background: Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. Methods: We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. Results: Compared with patients with STEMI (N=16,315), those with NSTEMI (N=5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs.71.4%), diaphoresis (48.6% vs.70.0%), radiation pain (26.4% vs.33.8%), and more likely to have chest distress (42.4% vs.38.3%) than STEMI patients (all P<0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval:1.849-2.107). Conclusions: Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction.
文摘目的探讨并分析急性非ST段抬高心肌梗死(NSTEMI)患者经皮冠状动脉介入治疗(PCI)术后血清纤维蛋白原/白蛋白值(FAR)、γ-谷氨酰转肽酶(γ-GGT),N端脑钠肽前体(NT-proBNP)水平对预后的预测价值。方法回顾性分析2020年2月至2023年2月邯郸市中心医院收治的实施PCI的急性NSTEMI患者93例,根据术后30 d主要不良心血管事件(MACE)发生情况将其分为MACE组(n=21)及无MACE组(n=72)。比较术前、术后30 d MACE组及无MACE组血清FAR、γ-GGT、NT-proBNP水平,采用单因素和多因素Logistic回归分析对影响急性NSTEMI患者术后30 d MACE发生的危险因素进行分析,采用受试者操作特征(ROC)曲线分析血清FAR、γ-GGT、NT-proBNP水平对急性NSTEMI患者术后MACE发生的预测价值。结果MACE组年龄为(65.37±3.46)岁;Killip分级为Ⅰ级2例,Ⅱ级3例,Ⅲ级5例,Ⅳ级11例;病变支数双支5例,3支16例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.87±0.55)%、(53.27±3.06)U/L、(914.35±84.35)ng/mL。无MACE组的年龄为(58.71±2.86)岁;Killip分级为Ⅰ级32例,Ⅱ级27例,Ⅲ级7例,Ⅳ级6例;病变支数为双支53例,3支19例;术后30 d血清FAR、γ-GGT、NT-proBNP水平分别为(2.12±0.51)%、(44.33±3.35)U/L、(656.82±75.63)ng/mL。MACE组和无MACE组的年龄、Killip分级、病变支数及术后30 d血清FAR、γ-GGT、NT-proBNP水平比较,差异均有统计学意义(P<0.05),两组性别、吸烟史、高血压史、高血脂史、糖尿病史及术前1 d血清FAR、γ-GGT、NT-proBNP水平比较差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示,血清FAR、γ-GGT、NT-proBNP升高均为影响急性期NSTEMI患者术后MACE发生的独立危险因素(OR=3.074、2.686、3.340,P均<0.05)。ROC结果显示血清FAR、γ-GGT、NT-proBNP及其联合检测预测急性NSTEMI患者术后MACE发生的曲线下面积(AUC)分别为0.681、0.690、0.733和0.790,联合检测的AUC更高(P<0.05)。结论血清FAR、γ-GGT、NT-proBNP水平升高增加了急性NSTEMI患者PCI术后MACE的发生风险,三者联合检测对患者术后不良预后有一定预测价值。