One Case of Primary Thrombocythemia with Concealed Hypokalemia Complicated by Acute Myocardial Infarction

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 × 109/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.

Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction： a multicenter random- ized clinical trial

在有单个容器中介狭窄犯人损害优点的心肌的梗塞(STEMI ) 病人进一步学习的尖锐圣片断举起的 stenting 的 BackgroundThe 利益 / 风险比率，因此现在的 study.Methods 和 resultsIt 的题目是一未来， multicenter，使随机化的控制试用。在 2012 年 4 月和 2015 年 7 月之间，有单个容器疾病和中介(40%-70%) 的 399 个尖锐 STEMI 病人在渴望 thrombectomy 或 intracoronary tirofiban 前后的犯人损害的狭窄(15 呍眠獡愠獳' 覒 X 整 ? 楷桴猠杩楮楦慣瑮椠灭潲敶敭瑮椠 ? ?癲癩污椠 ? 慰楴湥獴眠瑩 ??

Study of Adverse Events of Streptokinase Therapy in Patients with Acute ST Elevation Myocardial Infarction

Background: Despite of different adverse events, streptokinase (SK) is widely used to treat patients presented with acute ST segment elevation myocardial infarction. Objective: The purpose of the present study was to observe different adverse events in patients of acute ST segment elevation myocardial infarction receiving SK infusion. Methodology: This cross-sectional type of analytic observational study was carried out in the inpatient department of Cardiology at National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from December 23rd 2019 to February 22nd 2020 for a period of two (2) months. All patients diagnosed as acute ST segment elevation myocardial infarction receiving SK were included in the present study. Adverse events were documented through completing a questionnaire by reviewing the records in the medical file as well as interviewing with the patients. Result: In this study, 43 (26.2%) patients developed different types of adverse events and 121 (73.8%) had no complications following SK infusion. The most common adverse event was hypotension i.e. 26 (60.4%) and other adverse events were bleeding 8 (4.8%) and allergic reaction 7 (4.2%). Statistically significant higher rate of adverse events occurred in diabetic, hypertensive and dyslipidemia group which was 26 (56.5%) Vs. 17 (14.4%), p = 0.000, 37 (36.6%) Vs. 06 (09.5%), p = 0.000 and 18 (54.5%) Vs. 25 (19.1%), p = 0.000 respectively. The independent factors for the development of adverse events were smoking {OR: 5.1 with 95% CI (1.7 to 15.1), p = 0.003}, diabetes {OR: 14.9 with 95% CI (5.0 to 44.8), p = 0.000}, hypertension {OR: 5.1with 95% CI (1.7 to 15.1), p = 0.003} and dyslipidemia {OR: 4.6 with 95% CI (1.5 to 13.7), p = 0.007}. Conclusion: Streptokinase infusion was associated with different adverse events. Among them the commonest one was hypotension and other less common events were minor bleeding and minor allergic reaction. The adverse events were more frequently documented in patients who were smoker, diabetic, hypertensive and dyslipidemic.

Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.

Variations in non-ST-elevation myocardial infarction care across three levels of hospitals in China:analysis from the China Acute Myocardial Infarction Registry

Objective To explore the variation of treatment and outcomes for NSTEMI across different-level hospitals, which potentially influenced by unbalanced economy and disparate medical care.Methods The China AMI registry consists of 108 hospitals across three levels (province, prefecture and county) throughout China.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.

Clinical study on the effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

Objective:To investigate the clinical effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention.Method: From March 2014 to September 2016, we selected 190 patients with ST-segment elevation myocardial infarction with percutaneous coronary intervention, according to the admission time is divided into observation group and control group, the control group was treated with conventional therapy (aspirin, isosorbide dinitrate, metoprolol tartrate, clopidogrel sulfate, captopril, atorvastatin calcium and diuretics) and trimetazidine, observation group in the control group based on Tongxinluo combined treatment, each group of 95 cases, and hs-CRP, aldosterone, NT-proBNP, TNF-α, IL-6, and cardiac function (LVEDV,LVESV,LVEF,SV) were compared.Result: The Hs-CRP in the observation group was significantly lower than that in the control group;The aldosterone in the observation group was significantly lower than that in the control group;The levels of NT-proBNP, TNF-α and IL-6 in the observation group were significantly lower than those in the control group;LVVEV and LVESV were significantly lower in the observation group than in the control group, LVEF and SV were significantly higher than those in the control group.Conclusion:Tongxinluo combined with trimetazidine in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention in patients with clinical effect is better, stable plaque, effectively improve microcirculation and cardiac function, recommended a wide range of clinical application.

ST-segment elevation myocardial infarction in Kawasaki disease:A case report and review of literature

BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.

Plaque herniation after stenting the culprit lesion with myocardial bridging in ST elevation myocardial infarction: A case report

BACKGROUND Myocardial bridging(MB)is increasingly recognized to stimulate atherogenesis,which may contribute to an acute coronary syndrome.Stenting the coronary segment with MB has been recognized to have an increased risk of in-stent restenosis,stent fracture and coronary perforation.The safety and efficacy of stenting the culprit lesion with overlaying MB in ST elevation myocardial infarction(STEMI)as primary reperfusion therapy has not been established.CASE SUMMARY We reported a patient who presented with inferior STEMI with a culprit lesion of an acute thrombotic occlusion in the right coronary artery and thrombolysis and thrombin inhibition in myocardial infarction 0 flow.After the stent placement during primary percutaneous coronary intervention,intravascular ultrasound revealed MB overlying the stented segment where heavy atherosclerotic plaque were present.Likely due to the combination of plaque herniation or prolapse caused by MB,as well as local increased inflammation and thrombogenicity,acute stent thrombosis occurred at this region,which led to acute stent failure.The patient required an emergent repeated cardiac catheterization and placing a second layer of stent to enhance the radial strength and reduce the inter-strut space.CONCLUSION Plaque herniation or prolapse after stenting a MB segment in STEMI is a potential etiology for acute stent failure.

Penetrating Atherosclerotic Ulcer with Elevated Troponin in A Patient with Old Myocardial Infarction: A Case Report

Penetrating atherosclerotic ulcer(PAU),an uncommon etiology of acute aortic syndrome(AAS),is a potential cause of chest pain seen in emergency departments.As PAU may lead to electrocardiogram(ECG)changes or rarely,elevated troponin levels,it is most likely misdiagnosed as acute coronary syndrome(ACS).Hence,individuals with PAU may be offered potentially life-threatening treatment.This paper reports a case of a 81-year-old male who presented with intermittent chest pain with a history of old inferior myocardial infarction and stent placement in the left circumflex coronary artery(LCX)three years ago.Initially,he was diagnosed with non-ST-elevation myocardial infarction(NSTEMI)based on abnormal ECG changes and raised troponin I.However,emergency coronary angiography(CAG)showed no restenosis in the left circumflex coronary artery(LCX)but with mild stenosis in the left anterior descending artery(LAD)and right coronary artery(RCA).Computed tomographic angiography(CIA)of the whole aorta showed multiple atherosclerotic plaques with penetrating atherosclerotic ulcer in the aortic arch and descending aorta.Endovascular aortic repair with Ankura II covered stent was performed.This case study reminds us that it is clinically difficult to distinguish PAU from ACS.Upon excluding ACS from the diagnosis,we should take into consideration of PAU,especially in elderly patients with positive cTnI.

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。

NSTEMI患者PCI术后再入院风险预测模型的建立及验证

目的:探讨急性非ST段抬高型心肌梗死(NSTEMI)患者行直接PCI术后再入院的影响因素,并建立预测模型。方法:选取166例NSTEMI患者为研究对象,依据患者PCI术后1年内是否因心梗及心肌梗死并发症再入院分为再入院组(n=110)和未再入院组(n=56)。分析NSTEMI患者行直接PCI术后再入院的独立影响因素,并构建其风险预测模型列线图,绘制受试者工作特征(ROC)曲线来评估模型区分度,采用Hosmer-Lemeshow对模型进行拟合优度检验,绘制校准曲线评估模型准确度。结果:心率、有无肺炎病史、病变血管数、甘油三酯、B型利钠肽为NSTEMI患者经直接PCI术后再入院的独立预测因素(P<0.05)。构建预测模型列线图,ROC曲线显示,曲线下面积(AUC)为0.773,敏感度为70.9%,特异度为76.8%,Hosmer-Lemeshow拟合优度检验显示,差异无统计学意义(χ^(2)=8.329,P=0.351)。通过模型校准曲线提示列线图模型的实际曲线接近理想曲线。结论:心率、有无肺炎病史、病变血管数、甘油三酯、B型利钠肽为NSTEMI患者直接PCI术后再入院的独立预测因素,以此建立的预测模型列线图可直观、快捷的对该类患者再入院的风险进行评估。

Practice of reperfusion in patients with ST-segment elevation myocardial infarction in China:findings from the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project

Background:Reperfusion therapy is fundamental for ST-segment elevation myocardial infarction(STEMI).However,the details of contemporary practice and factors associated with reperfusion therapy in China are largely unknown.Therefore,this study aimed to explore reperfusion practice and its associated factors among hospitalized patients with STEMI in China.Methods:Patients with STEMI who were admitted to 159 tertiary hospitals from 30 provinces in China were included in the Improving Care for Cardiovascular Disease in China–Acute Coronary Syndrome project from November 2014 to December 2019.The associations of the characteristics of patients and hospitals with reperfusion were examined using hierarchical logistic regression.The associations between therapies and in-hospital major adverse cardiovascular events were examined with a mixed effects Cox regression model.Results:Among the 59,447 patients,37,485(63.1%)underwent reperfusion,including 4556(7.7%)receiving fibrinolysis and 32,929(55.4%)receiving primary percutaneous coronary intervention(PCI).The reperfusion rate varied across geographical regions(48.0%–73.5%).The overall rate increased from 60.0%to 69.7%from 2014 to 2019,mainly due to an increase in primary PCI within 12 h of symptom onset.Timely PCI,but not fibrinolysis alone,was associated with a decreased risk of inhospital major adverse cardiovascular events compared with no reperfusion,with an adjusted hazard ratio(95%confidence interval)of 0.64(0.54,0.76)for primary PCI at<12 h,0.53(0.37,0.74)for primary PCI at 12 to 24 h,0.46(0.25,0.82)for the pharmaco-invasive strategy,and 0.79(0.54,1.15)for fibrinolysis alone.Conclusions:Nationwide quality improvement initiatives should be strengthened to increase the reperfusion rate and reduce inequality in China.Trial registration:www.ClinicalTrials.gov,NCT02306616。

The impact of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction(STEMI)patients after emergency percutaneous coronary intervention(PCI).Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group(standard group,n=60),and 40 mg of atorvastatin treatment group(intensive group,n=60).

重组人脑利钠肽联合沙库巴曲缬沙坦对NSTEMI并发急性心力衰竭患者的影响

目的:研究重组人脑利钠肽联合沙库巴曲缬沙坦运用于非ST段抬高型心肌梗死(NSTEMI)并发急性心力衰竭患者中的价值。方法:选择2020年8月—2022年3月广东省河源市人民医院诊断为NSTEMI并发急性心力衰竭的住院患者共70例,通过随机数字表法分为研究组与对照组,各35例。研究组采用重组人脑利钠肽及沙库巴曲缬沙坦治疗,对照组采用重组人脑利钠肽及缬沙坦治疗。比较两组的总有效率、心率、血压及尿量、左心射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、氨基末端B型脑钠肽前体(NT-proBNP)、主要心血管不良事件(MACE)。结果:研究组总有效率(88.57%)高于对照组(68.57%),差异有统计学意义(P<0.05)。用药前,两组的心率、血压、尿量、肌酐、血钾比较,差异均无统计学意义(P>0.05);用药后72 h、7 d,研究组心率、收缩压、舒张压、肌酐均低于对照组,而尿量较对照组高,差异均有统计学意义(P<0.05);两组血钾比较,差异均无统计学意义(P>0.05)。用药前,两组的心功能及NT-proBNP比较,差异均无统计学意义(P>0.05)。用药后3、6个月,研究组的LVEF高于对照组,但LVEDD、LVESD、NT-proBNP均较对照组降低,差异均有统计学意义(P<0.05)。研究组心脏不良事件的发生率较对照组更低(P<0.05)。结论:重组人脑利钠肽联合沙库巴曲缬沙坦能够积极控制患者血压及心率,促进心功能改善,减少心脏不良事件的发生。

Chest pain and troponin elevation in a Duchenne Muscular Dystrophy:Acute myocardial infarction or progres-sion of Duchenne cardiomyopathy

Duchenne Muscular Dystrophy （DMD） is an X- linked disorder and presents in boys of early childhood with proximal muscle weak- ness, calf hypertrophy and markedly elevated creatine kinase levels. Weakness in DMD is progressive, and ambulation is lost early in the second decade1. The main clinical features of the patients are the proximal muscle weakness and atrophy, unusual walking posture,

Effect of late reperfusion therapy on cardiac function and prognosis in patients with acute ST elevation myocardial infarction

Background The suitable time for treating patients with acute ST elevation myocardial infarction （STEMI） is unclear. This study was to investigate the effects of reperfusion therapy at different late times on patients with acute STEMI, in order to decide the best time for late reperfusion therapy by providing evidence-based treatment in clinical practice. Methods We enrolled 1372 patients with STEMI and receiving selective percutaneous coro- nary intervention therapy between January 1st, 2010 to December 30th, 2014. According to the time receiving PCI, these patients were divided into 3 groups： 〈3 d（n=66） ,3-6 d（n=388） and/〉7 d （n=918）. The demograph- ic, clinical and coronary angiography data, and in-hospital major adverse clinical events （MACEs） were com- pared. Results The mortality rates among 3 groups were not statistically different （0 vs. 2.6% vs. 2.0%, P= 0.375）. The incidence rate of in-hospital MACEs in 3-6 d group was lower than the other two groups, but not sta- tistic difference （25.8% vs. 16.8% vs. 21.6%, P=0.077）. By comparing the cost of hospitalization, we found that the 3-6 d group was slight lower. For patients with non-occlusive culprit vessels, although the mortality rate still had no statistic difference, the incidence rates of in-hospital MACEs were different （33.3% vs. 11.7% vs. 15.9%, P=0.003）. However, the same conclusion was not driven in patients with occlusive target vessels. Conclusions For patients with STEMI receiving late reperfusion therapy, intervention during 3-6 d might have a trend to improve prognosis.

Trends of ST-segment elevation myocardial infarction in western rural China from 2001 to 2011—China PEACE retrospective acute myocardial infarction study

Objective To assess the trends in clinical characteristics and treatments for in-hospital patients with ST-segment elevation myocardial infarction(STEM)in western rural China from 2001 to 2011.Methods A two-stage random sampling procedure was used in our study.In 1st stage,stratified random sampling was applied to

Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction

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.