Severe Hypokalemia ECG Changes Mimicking Those of Acute Coronary Syndrome (ACS) in Patient with Underlying Ischaemic Heart Disease: A Case Review

Background: Hypokalemia is seen on regular basis in medical emergency. The definition of hypokalemia is serum potassium level below 3.5 mmol/L, meanwhile severe hypokalemia is serum potassium level below 2.5 mmol/L [1]. Patient with hypokalemia can present with wide range of presentation including musculoskeletal complaints from numbness to acute paralysis. Severe hypokalemia has tendency to progress to intestinal paralysis and respiratory failure. In some cases of hypokalemia, cardiovascular system can also be affected causing cardiac arrhythmias and heart failure [2]. Aim: This case report is to highlight that severe hypokalaemia can present with ECG changes mimicking acute coronary syndrome (ACS) which was fully resolved with correction of potassium level. Methods: We report a case of 84 years old Chinese man with underlying triple vessel disease presented with generalised body weakness for 2 days. ECG on arrival noted changes suggestive of ACS with ST segment depression in lead V4-V6 with first degree heart block, however patient had no ischemic symptoms and the potassium level was severe low at 1.6 mmol/L (3.5 - 5.1 mmol/L). He was correctly not treated for ACS. Outcomes: Repeated ECG post fast intravenous potassium correction noted complete resolution of the ST segment depression and first degree heart block. Patient discharged well from hospital four days later with potassium level of 3.8 mmol/L. Conclusions: Severe hypokalemia with asymptomatic ECG of ACS changes can safely be treated as a single entity clinical emergency with good resolution and no complication after normalizing potassium level.

Relationship between resistin level in serum and acute coronary syndrome or stable angina pectoris

Objective： To investigate the relationship between serum resistin level and acute coronary syndrome （ACS） or stable angina pectoris （SAP）. Methods： Sixty-five patients, with coronary artery disease, were enrolled and divided into three subgroups： acute myocardial infarction （AMI）, unstable angina pectoris （UAP） and SAP, and 26 healthy people were recruited as controls in the cross-sectional study. Serum resistin levels were determined by ELISA （enzyme-linked immunosorbent assay）, and WBC （white blood cell count）, hsCRP （high sensitive C-reaction protein）, CKmax （maximum of creatinkinase）, CK-MBmax （maximum of isozyme of creatinkinase） and cTnImax （maximum of troponin） were measured by standard laboratory methods. Results： The serum resistin levels were 4 folds higher in AMI patients, 2.43 folds in UAP patients and I. 12 folds in SAP patients than in the healthy controls （P〈0.05）. The resistin levels were also significantly different between AMI [（8.16±0.79） ng/ml], UAP [（5.59±0.75） ng/ml] and SAP [（3.45±0.56） ng/ml] groups （P〈0.01）; WBC, hsCRP, CK CK-MBmax and cTnlmax were significantly increased in AMI patients over UAP and SAP patients. Spearman analysis showed that serum resistin levels were positively correlated with WBC （r=0.412, P=0.046）, hsCRP （r=0.427,p=0.037）, CK CK-MBmax and cTnImax （r=0.731, 0.678, 0.656; P〈0.01）. Conclusion： Serum resistin levels increased with inflammatory factors and myocardial impairment. The results suggest that human resistin might play an important role in the pathogenesis of atherosclerosis and AMI as an inflammatory factor.

Interleukin-8 gene polymorphism is associated with acute coronary syndrome in a Han Chinese population

Background Acute coronary syndrome(ACS) is one of the most common forms of heart diseases.Recent studies have revealed that interleukin(IL)-8 plays a kev role in the development of atherosclerosis plaque and its complications, but the relationship of its common variants with ACS has not been extensively studied.Methods We tested the hypothesis that variants in IL-8-251 A/T was associated with susceptibility to ACS and its recurrence in a Chinese case-control study comprising 675 patients with ACS and 636 control subjects and replicated the investigation in an independent study comprising 360 cases and 360 control subjects. The plasma concentration of IL-8 was measured by enzyme-linked immunosorbent assay.Results IL-8 -251A】T poly-morphism was associated with increased susceptibility to ACS (P=0.004;OR=1.30 CI:1.12-1.53).Replication in the second study yielded similar results.IL-8 -251 A/T may affect the expression of IL-8 by the evidence that augmented IL-8 production revealed in serum of the AMI patients by ELISA. Conclusions IL-8 -251 A/T polymorphism is associated with ACS risk in Chinese Han population and An allele of IL-8- 251A/T may be an independent predictive factor.

Incidence, Risk Factors and Short Term Outcome of Acute Kidney Injury among Patients with Acute Coronary Syndrome

Background: Cardio-renal syndrome is the leading cause of death globally. Acute kidney injury (AKI) is a major complication among patients admitted in Coronary Care Unit (CCU) with acute coronary syndrome (ACS). AKI in ACS patients is associated with higher morbidity, mortality and prolong hospital stay. Objective: To determine the incidence, risk factors and short term outcome of acute kidney injury (AKI) among the patients admitted in CCU with ACS. Methods: This cross sectional study was conducted at Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2013 to December 2013. Following selection criteria a total of two hundred (200) patients with ACS were studied. AKI was defined according to the KDIGO guideline and further categorized by RIFLE criteria. Data of patients with AKI and those without AKI were analyzed and compared by statistical tests. Results: Majority of the study patients were male (79.5%). AKI was developed in 40 of the 200 study patients (20.0%). The mean (±SD) age of the study patients was 60.1 ± 11.1 years in patients with AKI and 55.9 ± 10.1 years in patients without AKI. Our data analysis showed that older age (>65 years), diabetes mellitus, dyslipidemia and smoking were significantly correlated to the development of AKI. Mortality was significantly high in AKI group (7.15%) compared to no AKI group (1.25%). Out of 27 patients who achieved renal recovery most (80.8%) belonged to risk class. Severity of AKI showed significant effect on renal recovery and final outcome. Conclusion: This study demonstrated that, incidence of AKI among patients with ACS was 20%. Elderly patients, diabetes mellitus, dyslipidemia, and exposure to smoking were significantly associated with development of AKI in ACS.

Clinical significance of monocyte-derived dendritic cell activation in patients with acute coronary syndrome

Background: Acute coronary syndrome (ACS) is an amplified state of inflammation and immune reaction. Dendritic cells (DCs) expressing various Toll-like receptors (TLRs) have been observed in atherosclerotic lesions, however, the clinical significance of DCs in pathogenesis of ACS has not been completely investigated. Methods: Ten patients with ACS and 10 patients with stable angina pectoris (SAP) were enrolled in this study. Monocyte-derived DCs were generated from CD14+ cells by culturing with granulocyte macrophage colony-stimulating factor and interleukin (IL)-4 for 6 days. Expression of cell surface CD86 and CD83 were measured by flowcytometry. Expression of genes, including CD86, CD83, CCL19, CCR7, TLR2, TLR4, TLR5, TLR8, and TLR9, were measured by real-time PCR. Plasma IL-6 and tumor necrosis factor (TNF)-α levels were also measured. Results: The number of CD86+CD83+DCs in the ACS group was significantly higher than that in the SAP group (P P P +CD83+ cells and plasma levels of IL-6 (P = 0.88, P +CD83+ cells TNF-α levels (r = 0.78, P < 0.0001). Conclusions: These results demonstrated that mono-cyte-derived DCs are activated in patients with ACS, suggesting that activated DCs may play an important role in the pathogenesis of ACS.

QRS Fragmentation as a Prognostic Test in Acute Coronary Syndrome

Background-Rationale of the Study: Among several invasive and non-invasive tests for risk stratification of acute coronary syndromes (ACS), fewer markers can be utilized in clinical practice. Our rationale is to validate use of QRS-fragmentation as a promising bed-side test for assessment of prognosis in those patients. Methods and Results: Collection of two-hundred and twenty patients with ACS was done during two years (from January 2011 till January 2013). Significant organic vaLVe disease and QRS duration ≥ 120 ms as well as patients with permanent pacemakers were excluded. Patients were subjected to full clinical examination, ECG and Echocardiography in the first day of admission followed by diagnostic coronary angiography before discharge and a nuclear study was done for Randomized sample from each group. 12-leads ECG revealed fragmentation of QRS in 74 patients and 146 patients with no QRS fragmentation. Localization of the infarct site revealed NS difference between percentages in both groups. Echocardiography revealed a significant deterioration of LV functions in group-A than group-B. Also, MR jet area was significantly higher in group-A. Coronary angiography revealed severer lesions in group-A more than group-B. Nuclear study revealed higher percentages of irreversible scars in group-A (30%) and higher reversibility in group-B (80%). In-hospital Occurrence of complications from ACS revealed a significant higher incidence of MACE in group-A. Conclusion: Presence of fragmented QRS in surface ECG during ACS represents myocardial scar or fibrosis and reflects the severity of coronary lesions and a correlation between fQRS and depression of LVfunction is established. Indeed, occurrence of MACE is suspected.

Impact of Baseline LDL-C and Lp(a) Elevation on Coronary Revascularization in Patients with Acute Coronary Syndrome One-Year after First Percutaneous Coronary Intervention

Objective: The aim of this study was to investigate the effect of Lipoprotein-a [Lp(a)] on Coronary Revascularizaton (CR) on one year follow up in patients with Acute Coronary Syndrome (ACS) after the first Percutaneous Coronary Intervention (PCI). Method: A retrospective study was designed. A total of 475 patients that underwent their first PCI treatment due to ACS between January 2016 and December 2017 were recruited and followed for one year at the Zhongda Hospital, China. The clinical end point after first PCI was prevalence of Major Adverse Cardiovascular Events (MACE) including nonfatal Myocardial Infarction (MI), cardiovascular death, ischemic stroke and Coronary Revascularization (CR). According to the cut point of Lp(a), participants were divided into low Lp(a) subgroup (Lp(a) mg/L) and high Lp(a) subgroup (Lp(a) ≥ 300 mg/L). Furthermore, based on baseline Low Density Lipoprotein Cholesterol (LDL-C) level, participants were divided into low LDL-C (LDL-C mmol/L) and high LDL-C (LDL-C ≥ 1.8 mmol/L) subgroups. Results: The number of prevalence of CR was higher with elevated serum Lp(a) in both low LDL-C subgroup and high LDL-C subgroup, and was significantly different in both the low LDL-C subgroup and high LDL-C subgroup (p = 0.009 and p = 0.006, respectively). Multivariate Cox-hazard regression analysis for CR showed increase in serum LDL-C and Lp(a) increased prevalence of CR by 1.514 and 1.002 folds respectively. Furthermore, Kaplan-Meier cumulative survival curves showed that increased prevalence of CR within one year after first PCI in patients with high Lp(a) [log rank p = 0.000]. Conclusion: Baseline increase of serum LDL-C and Lp(a) significantly increases the prevalence of CR after first PCI within one year. It indicates that after PCI treatment, in patient with serum LDL-C and Lp(a) elevation, treatment with high-dose statin therapy or PCSK9 inhibitors may alleviate the adverse effects imposed by Lp(a) elevation.

Acute coronary syndromes: more or less antithrombotic medication for the elderly?

The treatment of elderly patients with acute coronary syndromes (ACS) remains challenging. About two thirds of patients with ACS and four fifth of patients who died from ACS are older than 65 years.

ECG after near-drowning mimicking acute coronary syndrome with left main coronary artery involvement

We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.

Research on the Interventional Effects of Stress Psychological Nursing Method on Patients with Acute Coronary Syndrome

Objective: To investigate the interventional effects of stress psychological nursing method on patients with acute coronary syndrome (ACS). Methods: 100 patients with ACS who were rescued in the emergency department and department of cardiology of our hospital between January 2017 and December 2017 were enrolled. According to the random number method, the patients were divided into control group and observation group. There were 50 patients in each group. The interventions were given as routine nursing and stress psychological nursing, and the results of the two interventions were compared. Results: Before the intervention, there was no difference in the general clinical data between the control group and the observation group, which was not statistically significant;after the intervention for anxiety and depression, average hospitalization time, and off-bed time, the difference in data between the control group and the observation group on anxiety and depression was statistically significant. Moreover, the values of all the observation groups were lower than those of the control group. Conclusion: Applying stress psychological nursing method to the nursing of the patients with ACS can significantly improve their anxiety and depression, which significantly improves their quality of life, and enables the patients to better grasp the relevant health knowledge, at the same time, it obtains good intervention effects, which is worth promoting in a wider clinical scope.

三种心电图标准对疑似ACS合并完全性左束支传导阻滞时被视为STEMI等危征的诊断价值

目的 探讨使用三种心电图诊断标准对急诊科拟诊为急性冠脉综合征(ACS)患者合并完全性左束支传导阻滞(CLBBB)时被视为ST段抬高型心肌梗死(STEMI)等危征,最终经急诊冠脉造影证实发生急性心肌梗死的诊断能力。方法 回顾性分析41例在急诊科拟诊为ACS合并CLBBB的患者,均经急诊完善冠脉造影后收入心内科重症监护单元(CCU),最终诊断分为AMI组(n=15)和非AMI组(n=26),分别使用巴塞罗那标准、Sgarbossa标准和Smith标准对两组患者心电图进行评测,绘制各诊断标准受试者工作特征(ROC)曲线,并得出ROC曲线下面积(AUC),分别计算敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)和准确度(CP),并进行解读。结果 巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时,经急诊冠脉造影证实诊断并治疗的AMI的AUC为0.947(P<0.001),其SEN、SPE、PPV、NPV、CP分别为92.9%、92.0%、86.7%、95.8%、92.3%;Sgarbossa≥3标准诊断AMI的AUC为0.647(P=0.120),其SEN、SPE、PPV、NPV、CP分别为35.7%、96.0%、83.3%、72.7%、74.4%;Sgarbossa≥2标准诊断AMI的AUC为0.604(P=0.273),其SEN、SPE、PPV、NPV、CP分别为42.9%、84.0%、60.0%、72.4%、69.2%;SmithⅢ标准诊断AMI的AUC为0.795(P=0.002),其SEN、SPE、PPV、NPV、CP分别为71.4%、92.0%、83.3%、85.2%、84.6%;SmithⅣ标准诊断AMI的AUC为0.656(P=0.099),其SEN、SPE、PPV、NPV、CP分别为50.0%、84.0%、63.6%、75.0%、71.8%;SmithⅤ标准诊断AMI的AUC为0.614(P=0.228),其SEN、SPE、PPV、NPV、CP分别为28.6%、96.0%、80.0%、70.6%、71.8%。巴塞罗那标准对在急诊科拟诊为ACS患者合并CLBBB时经急诊冠脉造影证实,诊断AMI的AUC、SEN、SPE、PPV、NPV、CP均高于Sgarbossa标准和Smith标准(P<0.001)。结论 急诊科拟诊为ACS合并CLBBB的患者中,应用心电图的巴塞罗那标准诊断AMI具有准确、简洁、实用的特点。

介入治疗后ACS患者中医证候要素分布特征的现况调查

目的调查介入治疗后急性冠脉综合征（ACS）患者中医证候要素的分布规律。方法采用横断面研究设计．ACS患者于介人治疗成功后24—48h内调查其病史、症状、体征及证候要素特点，利用冠心病中医临床科研共享系统进行数据录入和管理．应用SPSS13．0进行统计分析。结果共调查5家医院480例介入治疗成功的ACS患者，其中血瘀占81．7％，痰浊偏寒占22．5％，痰浊偏热占18．3％，气虚占51．7％，阴虚占42．5％，阳虚占10．8％。证候要素组合情况显示：2个证候要素相兼占52．5％，3个证候要素相兼占23．3％，单证候要素占14．2％，4个证候要素占10．0％。其中血瘀与痰浊（包括偏寒与偏热）相兼占34．2％，血瘀与气虚相兼占44．2％，血瘀与阴虚相兼占32．5％．气虚与阴虚相兼占26．7％。结论介入治疗后ACS患者证候要素主要是血瘀、气虚，证候要素组合以2个证候要素组合最常见，其中以血瘀兼气虚组合最常见。

大株红景天对ACS患者心功能的影响研究

目的:研究大株红景天对急性冠脉综合征(ACS)患者心功能的影响。方法:将本院2012年2月-2013年2月收住院的120例ACS患者随机分为A组(常规治疗组)和B组(大株红景天治疗组),每组为60例。A组给与ACS的常规治疗如:阿司匹林、氯吡格雷、低分子肝素等,B组患者在常规治疗基础上给与大株红景天注射液10ml静脉点滴7天,每日1次。观察两组患者用药7天前后心功能指标的变化,研究大株红景天注射液对心功能的影响。结果:A、B两组患者经治疗后,血浆脑钠肽前体(NT-proBNP)、心脏射血分数(EF值)均有明显改善(P=0.000),但B组较A组NT-proBNP减低更显著(P<0.001),EF值提高更明显(P<0.009)。结论:在常规治疗基础上加用大株红景天注射液治疗ACS,可更明显降低血浆NT-proBNP水平、提高心脏EF值。大株红景天注射液可明显改善ACS患者的心功能。

血浆B型钠尿肽检测对ACS危险分层和预后判断的意义

目的探讨血浆B型钠尿肽（BNP）快速床旁检测对急性冠脉综合征（ACS）危险分层和预后判断的意义。方法ACS患者67例[ST段抬高心肌梗死（STEMI）组27例、非STEMI（NSTEMI）组20例、不稳定型心绞痛（UA）组20例]和稳定型心绞痛（SA）患者20例，入院24h内行床旁BNP快速测定，随访并对比分析30、90d内主要不良心脏事件（MACE）。结果ACS患者血浆BNP（559．59±535．16）（pg／m1）明显高于SA患者的（23．28±11．69）（pg／m1）（P〈0．05）；其中，STEMI组（1050．59±932．31）（pg／ml），明显高于NSTEMI组的（357．65±263.48）（pg／m1）和UA组的（98．69±96．99）（pg／ml）（P〈0．05）；冠脉3支病变组（972．54±224．05）（pg／ml），明显高于1支病变组的（249．29±192．10）（pg／ml）（P〈0．01）；BNP对30d内病死率预测的ROC曲线下面积（AUC）为0．89（95％CI为0．81～0．97）（P〈0．05）；当BNP〉100pg／ml时其敏感性75％，特异性97％，准确性81％；3个月MACE预测的AUC为0．79（95％CI为0．67～0．90）（P〈0．05），当BNP〉100pg／ml时其敏感性84％，特异性69％，准确性64％。结论ACS患者床旁快速检测BNP水平有助于ACS的危险分层和预后判断。

同型半胱氨酸和B型尿钠肽在诊断ACS中的临床应用

目的探讨同型半胱氨酸(Hcy)和B型尿钠肽(BNP)分析在诊断急性冠状动脉综合征(ACS)中的临床意义,为ACS的诊断和治疗提供新的理论依据。方法应用循环酶法分析97例急性冠状动脉综合征和38例正常对照组血清中Hcy和BNP水平。结果 97例急性冠状动脉综合征患者较之38例正常对照组血清中Hcy和BNP显著增高(p<0.05;p<0.01)。结论血清Hcy和BNP与急性冠状动脉综合征密切相关,并具有诊断和治疗随访的临床价值。

阿托伐他汀预处理对PCI治疗的ACS患者血脂及cTnI、CKMB水平的影响

目的探讨阿托伐他汀预处理对经皮冠状动脉介入治疗(PCI)患者血清脂质及心肌肌钙蛋白I(cTnI)和肌酸激酶同工酶(CK-MB)水平的影响。方法选取河北医科大学第一医院2016年6月-2018年6月收治的符合纳入标准的90例急性冠脉综合征患者,采用随机数字表法分为观察组(n=45)及对照组(n=45)。两组患者术前均常规给予口服阿司匹林100 mg、氯吡格雷300 mg及静脉输注普通肝素(80 IU/kg)等药物治疗。观察组术前给予阿托伐他汀40 mg(立普妥20 mg/片,辉瑞)口服,对照组术前给予安慰剂100 mg(维生素C片剂)口服。两组术后口服阿托伐他汀(20 mg/d),疗程3个月。患者出院后随访1年。结果两组术前血清总胆固醇(TC)、甘油三酯(TG)和低密度脂蛋白(LDL-C)水平差异无统计学意义(P<0.05)。两组患者术后7 d血脂水平较术前及术后第1天明显下降(P<0.05),且观察组显著低于对照组(P<0.05)。两组患者术前超敏C反应蛋白(hs-CRP)水平差异无统计学意义(P=0.898),两组患者术后1 d hs-CRP水平较术前均显著增高,但组间差异无统计学意义(P=0.135),术后7 d hs-CRP水平明显低于术后1 d(P=0.000),观察组明显低于对照组(P=0.000)。两组术前cTnI和CK-MB水平差异无统计学意义(P<0.05),术后1 d cTnI和CK-MB水平明显高于术前(P=0.000),但两组间差异无统计学意义(P<0.05),术后7 d cTnI和CK-MB水平较术后1 d显著下降(P=0.000),且观察组显著低于对照组(P=0.000)。观察组总不良心血管事件发生率低于对照组,差异有统计学意义(P=0.01)。结论阿托伐他汀预处理可有效降低患者的血脂和cTnI、CK-MB水平,降低不良心血管事件发生率。

AT-Ⅲ活性和NT-proBNP检测联合GRACE评分对NSTE-ACS患者远期预后的评估价值

目的分析抗凝血酶(AT-Ⅲ)、N末端脑钠肽前体(NT-proBNP)检测联合全球急性冠状动脉事件注册(GRACE)评分对非ST段抬高性急性冠状动脉综合征(NSTE-ACS)患者远期预后的评估价值。方法选取2017年1月至2018年1月本院收治的94例NSTE-ACS患者作为NSTE-ACS组,计算所有NSTE-ACS患者GRACS评分,分为三个亚组[低危组(n=39)、中危组(n=34)和高危组(n=21)]。选取同期因疑似冠心病而住院,并经冠状动脉造影术证实血管狭窄直径<50%、血流正常且临床资料完整的60例非冠心病者为对照组;比较NSTE-ACS组与对照组AT-Ⅲ活性、NT-proBNP水平差异,采用ROC曲线分析AT-Ⅲ活性、NT-proBNP水平、GRACE评分及三者联合对NSTE-ACS患者预后不良的预测价值,采用Logistic回归分析影响NSTE-ACS患者预后不良的危险因素。结果 NSTE-ACS组AT-Ⅲ活性低于对照组,LgNT-proBNP水平高于对照组,差异均具有统计学意义(P<0.05)。NSTE-ACS三个亚组AT-Ⅲ活性比较:低危组>中危组>高危组,NT-proBNP水平比较:低危组<中危组<高危组,差异均具有统计学意义(P<0.05)。截至随访结束,94例NSTE-ACS患者共26例出现MACE,68例未出现MACE,预后不良率为27.66%,分别将其分为MACE组及无MACE组。MACE组、无MACE组年龄、低密度脂蛋白胆固醇、左心室射血分数、AT-Ⅲ活性、LgNT-proBNP水平、GRACE评分及吸烟之间比较差异具有统计学意义(P<0.05)。左心室射血分数、AT-Ⅲ活性、LgNT-proBNP水平、GRACE评分为影响NSTE-ACS患者出现预后不良的多因素(P<0.05)。各指标曲线下面积以联合检测最大。结论 AT-Ⅲ活性、LgNT-proBNP水平、GRACE评分为影响NSTE-ACS患者出现MACE的独立危险因素,联合检测三指标可作为预测患者预后并发MACE的有效手段。

Hcy与ACS冠状动脉狭窄程度及其心血管事件的相关性

目的：探讨血清同型半胱氨酸（Hcy）与急性冠状动脉综合征（ACS）患者冠状动脉狭窄程度及其心血管事件的相关性。方法选取确诊为ACS并行冠状动脉造影检查的患者100例，按照血清Hcy值分为两组，A组（Hcy≤15μmol/L/L），B组（Hcy＆gt;15μmol/L/L）。分析Hcy与ACS冠状动脉狭窄程度及其心血管事件的相关性。结果 A组有意义冠状动脉狭窄率52.00%，B组有意义冠状动脉狭窄率86.00%，两组比较差异有统计学意义。A组患者总心血管事件发生率34.00%，B组患者总心血管事件发生率72.00%，两组比较差异有统计学意义。结论血清Hcy与ACS冠状动脉狭窄程度及其心血管事件具有明显的相关性。

急诊床旁检测NT—proBNP对ACS患者院内主要不良心血管事件的预测价值

目的探讨急诊床旁检测N末端B型利钠肽（NT—proBNP）对急性冠脉综合征（ACS）患者院内主要不良心血管事件（MACE）的预测价值。方法急诊ACS患者164例，其中非ST段抬高型ACS（NSTEACS）83例；ST段抬高型ACS（STEACS）81例。人急诊10min内床旁检测NT—proB-NP等生物标记物水平，症状发作距床旁检测平均时间（6．73±6．57）h。记录急诊至心脏科再灌注前发生的院内MACE，包括：急性心力衰竭（AHF）、室性心律失常伴血流动力学不稳（VA）和全因死亡（ACD）。根据有无发生院内MACE分为A组和B组，将组间比较差异有统计学意义的指标经单因素分析判断其与院内MACE的相关性，再将显著相关指标通过Logistic回归筛选独立预测因子，并以ROC曲线下面积（AUC）评价其对院内MACE的预测效能。结果入选病例共发生院内MACE53例（32．32％），死亡11例（6．71％）。A组与B组NT—proBNP水平（10533．11±9346．76）pg／mLV8．（457．75±448．77）pg／mL，P〈0．001。单因素分析显示：年龄、心率、cTnI、Myo、NT—proBNP、Fib、D—dimer、WBC、CRE、UA升高与ACS患者院内MACE相关（P〈0．05）。Logistic回归显示：NT—proBNP是ACS患者院内MACE的独立预测因子（P〈0．001，OR=1．003，95％CI1．001—1．005）。NT—proBNP预测院内MACE的AUC为0．973（95％CI0．942—1．000），界值为2016pg／mL（敏感度0．943，特异度1．000，阴性预测值0．974，阳性预测值1．000）；预测院内MACE中单一终点事件AHF、VA和ACD的AUC分别为0．983（95％c10．960—1．000）、0．916（95％c10．830-1．000）和0．961（95％CI0．932—0．990），界值分别为2016pg／mL、5817pg／mL．和8072pg／mL。结论急诊早期NT—proBNP床旁检测可快速、高效、准确地独立预测再灌注前ACS患者院内MACE，当检测值大于2016pg／mL、5817pg／mL和8072pg／mL时可分别预警院内AHF、VA和ACD。

急性冠状动脉综合征(ACS)患者血清miR-186-5p,miR-23和miR-652水平检测的临床意义

目的探讨急性冠状动脉综合征(acute coronary syndrome,ACS)患者血清miR-186-5p,miR-23b和miR-652水平检测的临床意义。方法选择2016年1月~2018年1月在延安大学附属医院行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)手术的ACS患者68例作为观察组,另外选取同期做冠脉造影符合冠心病诊断,但排除ACS的患者68例作为对照组。收集两组受试对象外周血,检测血清中miR-186-5p,miR-23b和miR-652水平,并进行相关性分析。绘制ROC曲线分析miR-186-5p,miR-23b和miR-652单个指标及联合使用诊断ACS的临床价值。结果与对照组比较,观察组患者血清中miR-186-5p,miR-23b和miR-652水平均提高,差异有统计学意义(Z=3.312~6.451,均P<0.05)。不同病变支数的ACS患者血清中miR-186-5p,miR-23b和miR-652的水平比较不全相同,差异有统计学意义(F=6.017~8.151,均P<0.05)。与术前比较,术后患者血清中miR-186-5p,miR-23b和miR-652水平显著降低,差异有统计学意义(Z=2.090~3.036,均P<0.05)。ACS患者血清中miR-186-5p,miR-23b和miR-652水平与cTnI呈显著相关(r=0.689,0.779,0.746,均P=0.000)。其临界值、AUC,灵敏度和特异度,miR-186-5p依次为0.110,0.775,61.8%和91.2%;miR-23b依次为0.133,0.799,69.1%和88.2%;miR-652依次为0.164,0.789,67.6%和91.2%。三者联用AUC,灵敏度和特异度分别为0.941,91.2%和83.8%。cTnI的AUC灵敏度和特异度分别为0.857,76.5%和79.4%。miRNAs联合AUC显著高于cTnI(Z=2.243,P<0.05)。结论ACS患者血清中miR-186-5p,miR-23b和miR-652水平升高,联合使用诊断ACS具有一定的临床价值。