Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose conce...Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose concentrations on short- and long-term mortality in patients with acute MI undergoing primary or rescue percutaneous coronary intervention(PCI). Methods: We analyzed the 30-day and long-term(mean follow-up 3.7 years)outcome of 978 patients prospectively included in a single-center registry of patients with acute MI treated with PCI within 24 hours after onset of symptoms. Patients were classified according to plasma glucose levels at admission:< 7.8 mmol/L(group I, n=322), 7.8 to 11 mmol/L(group II, n=348), and >11.0 mmol/L(group III, n=308). Results: Mortality at 30 days was 1.2% in group I, 6.3% in group II, and 16.6% in group III(P< .001). After multivariate adjustment for age, the presence of cardiogenic shock, and TIMI 3 flow after PCI, the association of mortality with glucose classification remained significant(P value for trend=.003). The relative risk of death at 30 days for group III versus group I was 3.9(95% CI 1.2- 13.2). During long-term follow-up, mortality was similar in groups I and II. However, in group III adjusted mortality remained significantly increased compared with group I(relative risk 1.76, CI 1.01- 3.08). Conclusions: In patients undergoing emergency PCI for acute MI, glucose levels at hospital admission are predictive for short- and long-term survival. Knowledge of admission glucose levels may improve initial bedside risk stratification.展开更多
目的探讨急诊经皮冠状动脉介入(PCI)冠脉内注射前列地尔对急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注水平和临床预后的影响。方法连续入选STEMI急诊PCI治疗的患者80例,随机分为对照组及治疗组各40例。对照组常规行PCI治疗,试验组...目的探讨急诊经皮冠状动脉介入(PCI)冠脉内注射前列地尔对急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注水平和临床预后的影响。方法连续入选STEMI急诊PCI治疗的患者80例,随机分为对照组及治疗组各40例。对照组常规行PCI治疗,试验组在对照组治疗基础上开通血管后冠脉内注射前列地尔。观察两组心肌组织灌注水平及主要心血管事件(MACE)的发生情况。结果治疗组PCI术后梗死相关血管TIMI血流分级(TFG)Ⅲ级获得率及术后1 h ST段回落程度明显高于对照组,校正TIMI血流计数帧数(CTFC)显著少于对照组(P<0.05);治疗组术中慢血流和院内MACE的发生率明显少于对照组,术中无复流及30 d的MACE与对照组无统计学差异(P>0.05)。结论 STEMI患者PCI术中开通梗死相关血管后冠脉内注射前列地尔可改善心肌微循环,增加心肌灌注,减少慢血流及院内MACE。展开更多
文摘Background: In patients with acute myocardial infarction(MI), increased plasma glucose levels at hospital admission are associated with worse outcome. We aimed to assess the predictive value of admission glucose concentrations on short- and long-term mortality in patients with acute MI undergoing primary or rescue percutaneous coronary intervention(PCI). Methods: We analyzed the 30-day and long-term(mean follow-up 3.7 years)outcome of 978 patients prospectively included in a single-center registry of patients with acute MI treated with PCI within 24 hours after onset of symptoms. Patients were classified according to plasma glucose levels at admission:< 7.8 mmol/L(group I, n=322), 7.8 to 11 mmol/L(group II, n=348), and >11.0 mmol/L(group III, n=308). Results: Mortality at 30 days was 1.2% in group I, 6.3% in group II, and 16.6% in group III(P< .001). After multivariate adjustment for age, the presence of cardiogenic shock, and TIMI 3 flow after PCI, the association of mortality with glucose classification remained significant(P value for trend=.003). The relative risk of death at 30 days for group III versus group I was 3.9(95% CI 1.2- 13.2). During long-term follow-up, mortality was similar in groups I and II. However, in group III adjusted mortality remained significantly increased compared with group I(relative risk 1.76, CI 1.01- 3.08). Conclusions: In patients undergoing emergency PCI for acute MI, glucose levels at hospital admission are predictive for short- and long-term survival. Knowledge of admission glucose levels may improve initial bedside risk stratification.
文摘目的:分析急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗急性心肌梗死(acute myocardial infarction,AMI)患者的病例资料,旨在探讨影响急诊PCI治疗AMI患者住院期间不良预后的相关因素。方法:回顾性分析2010年1月至2014年12月中南大学湘雅二医院行急诊PCI治疗AMI的患者资料,根据是否发生心血管不良事件分为事件组及非事件组,比较两组间可能引起心血管不良事件发生的相关因素。结果:不良事件的发生率为22%(67/304);通过t检验或χ2检验发现:肌酐,脑钠肽(brain natriuretic peptide,BNP),红细胞比容,白细胞、年龄>75岁,Killip分级≥2级,术后心肌梗死溶栓治疗(thrombolysis in myocardial infarction,TI MI)血流≤2级,术前发生心律失常、多支病变,术后2 h ST段回落率<50%,长就诊至球囊扩张(door-to-balloon,D2B)时间差异具有统计学意义(P<0.05),进一步进行logistic回归分析,其结果显示:红细胞比容(red blood cell specific volume,HCT)、N端脑钠肽激素原前体(N-terminal pro-brain natriuretic peptide,NTpro BNP)、Ki l lip分级≥2级、术后TI MI血流≤2级、术后2 h ST段回落率<50%、长D2B时间是心血管不良事件发生的重要影响因素。结论:HCT,NT-pro BNP,Killip分级≥2级,术后TIMI血流≤2级,术后2 h ST段回落率<50%、长D2B时间是心血管不良事件发生的重要影响因素,对上述高危患者进行积极的监测与处理,能够有效改善AMI患者急诊PCI术后的预后,减少住院期间不良事件的发生。
文摘目的探讨急诊经皮冠状动脉介入(PCI)冠脉内注射前列地尔对急性ST段抬高型心肌梗死(STEMI)患者心肌组织灌注水平和临床预后的影响。方法连续入选STEMI急诊PCI治疗的患者80例,随机分为对照组及治疗组各40例。对照组常规行PCI治疗,试验组在对照组治疗基础上开通血管后冠脉内注射前列地尔。观察两组心肌组织灌注水平及主要心血管事件(MACE)的发生情况。结果治疗组PCI术后梗死相关血管TIMI血流分级(TFG)Ⅲ级获得率及术后1 h ST段回落程度明显高于对照组,校正TIMI血流计数帧数(CTFC)显著少于对照组(P<0.05);治疗组术中慢血流和院内MACE的发生率明显少于对照组,术中无复流及30 d的MACE与对照组无统计学差异(P>0.05)。结论 STEMI患者PCI术中开通梗死相关血管后冠脉内注射前列地尔可改善心肌微循环,增加心肌灌注,减少慢血流及院内MACE。
