Assessment of post-myocardial infarction lipid levels and management:Results from a tertiary care hospital of Pakistan

BACKGROUND Lipid treatment practices and levels in post-acute myocardial infarction(AMI)patients,which are crucial for secondary prevention.AIM To evaluate the lipid treatment practices and lipid levels in post-myocardial infarction(MI)patients at a tertiary care hospital in Pakistan.METHODS In this cross-sectional study,we analyzed patients who had experienced their first AMI event in the past 3 years.We assessed fasting and non-fasting lipid profiles,reviewed statin therapy prescriptions,and examined patient compliance.The recommended dose was defined as rosuvastatin≥20 mg or atorvastatin≥40 mg,with target total cholesterol levels set at<160 mg/dL and target low-density lipoprotein cholesterol(LDL-C)at<55 mg/dL.RESULTS Among 195 patients,71.3%were male,and the mean age was 57.1±10.2 years.The median duration since AMI was 36(interquartile range:10-48)months and 60% were diagnosed with ST-segment elevation MI.Only 13.8% of patients were advised to undergo lipid profile testing after AMI,88.7% of patients were on the recommended statin therapy,and 91.8% of patients were compliant with statin therapy.Only 11.5% had LDL-C within the target range and 71.7% had total cholesterol within the target range.Hospital admission in the past 12 months was reported by 14.4%,and the readmission rate was significantly higher among non-compliant patients(37.5%vs 5.6%).Subsequent AMI event rate was also significantly higher among non-compliant patients(43.8%vs 11.7%).CONCLUSION Our study highlights that while most post-AMI patients received the recommended minimum statin therapy dose,the inadequate practice of lipid assessment may compromise therapy optimization and raise the risk of subsequent events.

Long-Term Prognosis of Different Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction in Chinese County-Level Hospitals:Insight from China Acute Myocardial Infarction Registry

Objective To evaluate the long-term prognosis of patients with ST-segment elevation myocardial infarction(STEMI)treated with different reperfusion strategies in Chinese county-level hospitals Methods A total of 2,514 patients with STEMI from 32 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014.The success of fibrinolysis was assessed according to indirect measures of vascular recanalization.The primary outcome was 2-year mortality.Results Reperfusion therapy was used in 1,080 patients(42.9%):fibrinolysis(n=664,61.5%)and primary percutaneous coronary intervention(PCI)(n=416,38.5%).The most common reason for missing reperfusion therapy was a prehospital delay>12 h(43%).Fibrinolysis[14.5%,hazard ratio(HR):0.59,95%confidence interval(CI)0.44–0.80]and primary PCI(6.8%,HR=0.32,95%CI:0.22–0.48)were associated with lower 2-year mortality than those with no reperfusion(28.5%).Among fibrinolysistreated patients,510(76.8%)achieved successful clinical reperfusion;only 17.0%of those with failed fibrinolysis underwent rescue PCI.There was no difference in 2-year mortality between successful fibrinolysis and primary PCI(8.8%vs.6.8%,HR=1.53,95%CI:0.85–2.73).Failed fibrinolysis predicted a similar mortality(33.1%)to no reperfusion(33.1%vs.28.5%,HR=1.30,95%CI:0.93–1.81).Conclusion In Chinese county-level hospitals,only approximately 2/5 of patients with STEMI underwent reperfusion therapy,largely due to prehospital delay.Approximately 30%of patients with failed fibrinolysis and no reperfusion therapy did not survive at 2 years.Quality improvement initiatives are warranted,especially in public health education and fast referral for mechanical revascularization in cases of failed fibrinolysis.

Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis

BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.

Fifteen years of bone marrow mononuclear cell therapy in acute myocardial infarction

In spite of modern treatment, acute myocardial infarction(AMI) still carries significant morbidity and mortality worldwide. Even though standard of care therapy improves symptoms and also long-term prognosis of patients with AMI, it does not solve the critical issue, specifically the permanent damage of cardiomyocytes. As a result, a complex process occurs, namely cardiac remodeling, which leads to alterations in cardiac size, shape and function. This is what has driven the quest for unconventional therapeutic strategies aiming to regenerate the injured cardiac and vascular tissue. One of the latest breakthroughs in this regard is stem cell(SC) therapy. Based on favorable data obtained in experimental studies, therapeutic effectiveness of this innovative therapy has been investigated in clinical settings. Of various cell types used in the clinic, autologous bone marrow derived SCs were the first used to treat an AMI patient, 15 years ago. Since then, we have witnessed an increasing body of data as regards this cutting-edge therapy. Although feasibility and safety of SC transplant have been clearly proved, it's efficacy is still under dispute. Conducted studies and meta-analysis reported conflicting results, but there is hope for conclusive answer to be provided by the largest ongoing trial designed to demonstrate whether this treatment saves lives. In the meantime, strategies to enhance the SCs regenerative potential have been applied and/or suggested, position papers and recommendations have been published. But what have we learned so far and how can we properly use the knowledge gained? This review will analytically discuss each of the above topics, summarizing the current state of knowledge in the field.

Direct Coronary Intervention Therapy in Patients with Acute Myocardial Infarction

Objective To introduce the initial experience of direct percutaneous transluminal coronary angioplasty(PTCA) and intracoronary stenting in patients with acute myocardial infarction(AMI) from October 1998 to November 2001 in our hospital. Methods Primary PTCA was performed in 38 patients with acute myocardial infarction.29 cases were 20 male and 9 female, ranging in age from 30 to 76 old years.23 cases had anterior and 15 had inferior wall infarction. The patients we chose for direct coronary intervention therapy had stable hemodynamics. Of the 38 infarct related arteries (IRA), 23 were left anterior descend arteries (LAD), 4 left circumflex (LCX) and 11 right coronary arteries (RCA). 33 IRA were TIMI 0 flow and 5 TIMI 1 flow. The indications for coronary stent implantation were: ① Acute reocclusion and high risk of reocclusion due to initial dissection after PTCA; ② Severe residual stenosis (stenosis of diameter≥50%) after repeated balloon dilation; ③ No response to recurrent infusions of Nitroglycerin in Obviously elastic recoil. Results Of the 38 patients with AMI, PTCA was successful in 35 Two patients were given up because 014 guide wire entered into false lumen. One was selected for emergency coronary artery bypass graft because of LAD infarct related artery accompanied by 70%stenosis of left main. 35 intracoronary stents were implanted.16 patients were followed up, of whom 2 patients had restenosis and were successful in the second attempt. Conclusion Direct PTCA and stent implantation are effective and safe means of treatment for AMI and stent implantation can prevent and cure the acute reocclusion after PTCA.

EFFECT OF REPERFUSION THERAPY ON SOLUBLE CELL ADHESION MOLECULES IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Objective To observe the changes of serum soluble intercellular adhesion moiecuie type-1(ICAM-1) and E-selectin in patients with acute myocardial inlarction (AMI) receiving reperfusiontherapy. Methods Peripheral venous blood samples were taken from 21 patients with AMI before and4,8,12,24,48,72h after thrombolytic treatment or direct percutaneous transluminal coronary angioplasty (PTCA).Blood samples from 16 control subjects were drawn for one time. Serum concentration of ICAM-1 and E-selectinwas determined by double antibodies sandwich enzyme-linked immunosorbent assay. Results Serum levels ofICAM-1 and E-selectin were higher in patients with AMI than those in controls. Sixteen patients with AMIand successful roperfusion therapy had signifcantly reduction in serum concentration of ICAM-1 and E-selectinat 24 and 48h, but had a peak at 4h. The remaining live patients who failed in mperfusion theropy didn’t show anysignificant changes in these values. Conclusion The serum concentration of ICAM-1 and E-selectin waselevated significantly in patients with AMI Successful reperfusion therapy can reduce the increased serumconcentration.

Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke

BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.

Predictors and in-hospital prognosis of recurrent acute myocardial infarction

为了调查作出贡献的因素和病人的在里面医院预后与或没有周期性的尖锐心肌的梗塞(AMI ) ， 1686 个连续 AMI 病人全部的 .MethodsA 承认到 2015 年 12 月的从 2010 年 1 月的医院被招募到北京大学民族。他们的临床的特征回顾地与或没有周期性的 AMI 在病人之间被作比较。然后 multivariable 逻辑回归被用来估计周期性的心肌的 infarction.ResultsRecurrent AMI 病人的预言者更旧(69.3 #

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 ??

Effectiveness and safety of antithrombotic strategies in elderly patients with acute myocardial infarction

BACKGROUND Elderly patients represent a rapidly growing part of the population more susceptible to acute coronary syndromes and their complications.However,literature evidence is lacking in this clinical setting.AIM To describe the clinical features,in-hospital management and outcomes of“elderly”patients with myocardial infarction treated with antiplatelet and/or anticoagulation therapy.METHODS This study was a retrospective analysis of all consecutive patients older than 80 years admitted to the Division of Cardiology of St.Andrea Hospital of Vercelli from January 2018 to December 2018 due to ST-elevation myocardial infarction(STEMI)or non-ST elevation myocardial infarction(NSTEMI).Clinical and laboratory data were collected for each patient,as well as the prevalence of previous or in-hospital atrial fibrillation(AF).In-hospital management,consisting of an invasive or conservative strategy,and the anti-thrombotic therapy used are described.Outcomes evaluated at 1 year follow-up included an efficacy ischemic endpoint and a safety bleeding endpoint.RESULTS Of the 105 patients enrolled(mean age 83.9±3.6 years,52.3%males),68(64.8%)were admitted due to NSTEMI and 37(35.2%)due to STEMI.Among the STEMI patients,34(91.9%)underwent coronary angiography and all of them were treated with percutaneous coronary intervention(PCI);among the NSTEMI patients,42(61.8%)were assigned to an invasive strategy and 16(38.1%)of them underwent a PCI.No significant difference between the groups was found concerning the prevalence of previous or in-hospital de-novo AF.10.5%of the whole population received triple antithrombotic therapy and 9.5%single antiplatelet therapy plus oral anticoagulation(OAC),with no significant difference between the subgroups,although a higher number of STEMI patients received dual antiplatelet therapy without OAC as compared with NSTEMI patients.A low rate of in-hospital death(5.7%)and 1-year cardiovascular death(3.3%)was registered.Seven(7.8%)patients experienced major adverse cardiovascular events,while the rate of minor and major bleeding at 1-year follow-up was 10%and 2.2%,respectively,with no difference between NSTEMI and STEMI patients.CONCLUSION In this real-world study,a tailored evaluation of an invasive strategy and antithrombotic therapy resulted in a low rate of adverse events in elderly patients hospitalized with acute myocardial infarction.

A comparative study of primary coronary stenting andintravenous thrombolysis for acute myocardial infarctionusing^(99m) Tc-MIBI SPECT imaging

The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after steming or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was eXPressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 = absence of activity. The scores of scanning before stenting or intravenous throm-bolysis was SBS. The scores of scaning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the steming group and thrombolysis group: SBS was 41.3+9.8 and 39.4+7.9 (t=1.2, p <0.05); SAS was 17.8+6.4 and 27.3+6.7 (t=5.8, p <0.01); SDS was 24.5+4.2 and 12.2+2.3 (t = 7.3, P <0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after steming. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between steming group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p <0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis.

The Effect of Predictive Nursing Intervention on Cardiac Function and Clinical Outcomes in CCU Patients with Acute Myocardial Infarction After Interventional Therapy

Objective:To evaluate the impact of predictive nursing on the care of acute myocardial infarction(AMI)patients in the Coronary Care Unit(CCU)after interventional therapy.Methods:From September 2021 to September 2023,84 AMI patients admitted to the CCU were randomly divided into two groups:the experimental group(42 patients)received predictive nursing,and the reference group(42 patients)received conventional nursing.Cardiac function and clinical outcomes were compared between the groups.Results:Before nursing,there was no difference in cardiac function between the two groups(P>0.05).After nursing,the cardiac function of the experimental group was better than that of the reference group(P<0.05).The clinical outcomes of the experimental group were better than those of the reference group(P<0.05).Before nursing,there was no difference in psychological scores between the two groups(P>0.05).After nursing,the psychological scores of the experimental group were lower than those of the reference group(P<0.05).Conclusion:Predictive nursing can improve the cardiac function and clinical outcomes of AMI patients after interventional therapy and can also regulate patients’negative psychological states.

Tenecteplase versus alteplase in treatment of acute ST-segment elevation myocardial infarction:A randomized non-inferiority trial

Background:A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator(rhTNK-tPA)has previously shown its preliminary efficacy in ST elevation myocardial infarction(STEMI)patients.This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase(rt-PA)in Chinese patients with STEMI.Methods:In this multicenter,randomized,open-label,non-inferiority trial,patients with acute STEMI were randomly assigned(1:1)to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min.The primary endpoint was recanalization defined by thrombolysis in myocardial infarction(TIMI)flow grade 2 or 3.The secondary endpoint was clinically justified recanalization.Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events(MACCEs)and safety endpoints.Results:From July 2016 to September 2019,767 eligible patients were randomly assigned to receive rhTNK-tPA(n=384)or rt-PA(n=383).Among them,369 patients had coronary angiography data on TIMI flow,and 711 patients had data on clinically justified recanalization.Both used a–15%difference as the non-inferiority efficacy margin.In comparison to rt-PA,both the proportion of patients with TIMI grade 2 or 3 flow(78.3%[148/189]vs.81.7%[147/180];differences:–3.4%;95%confidence interval[CI]:–11.5%,4.8%)and clinically justified recanalization(85.4%[305/357]vs.85.9%[304/354];difference:–0.5%;95%CI:–5.6%,4.7%)in the rhTNK-tPA group were non-inferior.The occurrence of 30-day MACCEs(10.2%[39/384]vs.11.0%[42/383];hazard ratio:0.96;95%CI:0.61,1.50)did not differ significantly between groups.No safety outcomes significantly differed between groups.Conclusion:rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery,a validated surrogate of clinical outcomes,among Chinese patients with acute STEMI.Trial registration:www.ClinicalTrials.gov(No.NCT02835534).

血清Cx43、Gal-9水平对老年急性脑梗死患者超早期静脉溶栓治疗预后的评估价值

目的探讨血清间隙连接蛋白43(Cx43)、半乳糖凝集素-9(Gal-9)水平对老年急性脑梗死(ACI)患者超早期静脉溶栓治疗预后的评估价值。方法选取2020年9月至2022年9月在该院行超早期静脉溶栓治疗的106例老年ACI患者作为研究组,另外选取同期来该院体检的100例体检健康者作为健康组。采用酶联免疫吸附试验(ELISA)检测所有研究对象的血清Cx43、Gal-9水平。治疗2周后参考美国国立卫生院卒中量表(NIHSS)评分将106例老年ACI患者分为预后良好组(81例)与预后不良组(25例)。采用受试者工作特征(ROC)曲线分析血清Cx43、Gal-9水平对老年ACI患者超早期静脉溶栓治疗预后的评估价值,采用多因素Logistic回归分析探讨老年ACI患者超早期静脉溶栓治疗预后不良的影响因素。结果研究组血清Cx43、Gal-9水平高于健康组(P<0.05);预后不良组血清Cx43、Gal-9水平高于预后良好组(P<0.05);血清Cx43、Gal-9预测老年ACI患者预后不良的曲线下面积(AUC)分别为0.721(95%CI:0.673~0.758)、0.837(95%CI:0.787~0.886),二者联合预测的AUC为0.901(95%CI:0.857~0.946)。预后不良组高血压占比高于预后良好组(P<0.05);多因素Logistic回归分析显示,高血压(OR=3.487,95%CI:1.564~7.773),血清Cx43≥106.53 pg/mL(OR=4.586,95%CI:1.982~10.611),血清Gal-9≥11.84 ng/mL(OR=4.345,95%CI:1.957~9.648)是老年ACI患者超早期静脉溶栓治疗预后不良的危险因素(P<0.05)。结论血清Cx43、Gal-9在老年ACI患者中均呈高表达,可用于评估老年ACI患者超早期静脉溶栓治疗的预后,二者联合检测的评估价值更高。

中性粒细胞绝对值、尿肾损伤分子1与经皮冠状动脉介入治疗后缺血再灌注急性肾损伤的相关性

目的探讨中性粒细胞绝对值(ANC)、尿肾损伤分子1(KMI-1)与急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后缺血再灌注急性肾损伤(AKI)的相关性。方法纳入行PCI的114例AMI患者为研究对象,根据患者PCI术后72 h内是否发生AKI分为AKI组和非AKI组。比较两组一般资料、PCI后2 h的ANC、尿KMI-1与其他实验室指标,分析ANC、尿KMI-1与AMI患者PCI后缺血再灌注AKI的关系。记录患者术后3个月心血管不良事件,分析ANC、尿KMI-1水平与心血管不良事件发生的关系。结果AKI组病变冠状动脉支数≥3支占比、ANC、C反应蛋白(CRP)、肌酐(Cr)、尿KMI-1水平均高于非AKI组,淋巴细胞绝对值(ALC)低于非AKI组,差异有统计学意义(Z=3.50,t分别=3.67、2.12、6.24、8.36、2.96,P均<0.05)。经logistic回归分析结果显示,ANC、Cr、尿KMI-1与AMI患者PCI后缺血再灌注AKI有关(OR分别=5.04、1.32、1.36,P均<0.05);ANC、尿KMI-1单独及联合模型预测的曲线下面积(AUC)为0.74、0.91、0.93。随访3个月发现,随着ANC、尿KMI-1升高,PCI后短期MACE发生率也随着升高(χ^(2)分别=13.77、9.36,P均<0.05)。结论ANC、尿KMI-1与AMI患者行PCI后缺血再灌注AKI有关,同时可提示AMI患者行PCI后短期预后情况,其机制与炎症反应有关。

强化降脂对急性ST段抬高型心肌梗死介入治疗的影响

目的 观察强化降脂对急性ST段抬高型心肌梗死介入治疗的影响。方法 选取2021年1月—2022年5月白银市第一人民医院收治的急性ST段抬高型心肌梗死介入治疗患者71例,采用随机数字表法分为试验组36例和对照组35例。对照组给予注射用阿替普酶治疗,试验组在对照组治疗基础上给予阿托伐他汀钙片治疗,2组均连续治疗21 d。比较2组临床疗效,治疗前后心功能指标[左室射血分数(LVEF)、左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)]、血脂指标[低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇(TC)及三酰甘油(TG)]、血液生化指标[超氧化物歧化酶(SOD)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)]。结果 试验组治疗总有效率为97.22%,高于对照组的77.14%(χ^(2)=4.777,P=0.029)。治疗21 d后,2组LVEF高于治疗前,LVESD、LVEDD小于治疗前,且试验组升高/减小幅度大于对照组(P<0.01);2组LDL-C、TC、TG水平与CK-MB、cTnT水平低于治疗前,HDL-C与SOD水平高于治疗前,且试验组降低/升高幅度大于对照组(P<0.05或P<0.01)。结论 强化降脂可提高急性ST段抬高型心肌梗死介入治疗的临床效果,可有效改善患者心功能,缓解心肌损伤,调节血脂。

Starting thrombolytic therapy for patients with acute myocardial infarction in Accident and Emergency Department:from implementation to evaluation

Objective To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and Emergency Department. Methods From January 1993 to December 1995, all AMI patients who were admitted to the United Christian Hospital and given thrombolytic therapy were studied. The patients' demographic data, time and mode of presentation, site of myocardial infarction, treatment modality and timing, and complications related to AMI or treatment were recorded prospectively in our AMI database. The frequency of thrombolysis administered in Accident and Emergency Department and Coronary Care Unit, as well as the median door-to-needle time (time interval between hospital arrival to initiation of thrombolytic therapy) were compared. Cases of inappropriate thrombolysis and complication were also analyzed.Results Over these 3 years, 257 patients received thrombolysis in the United Christian Hospital. The percentage of patients receiving thrombolysis in Accident and Emergency Department increased from 3.2% in 1993 to 12.3% in 1994, and to 39.4% in 1995. The median time interval between arrival to hospital and thrombolysis (door-to-needle time) was 25 minutes, compared with 81 minutes in the Coronary Care Unit. The door-to-needle time also improved over these 3 years: from 95 minutes in 1993 to 75 minutes in 1995 in Coronary Care Unit group, and from 35 minutes in 1993 to 20 minutes in 1995 in the Accident and Emergency Department group. Over these 3 years, 2 cases of inappropriate thrombolysis were reported but these did not result in any mortality. Four complications from thrombolytic therapy were reported, and these were managed appropriately by the staff in Accident and Emergency Department and did not result in mortality. Conclusions Starting thrombolytic therapy in Accident and Emergency Department is safe and effectively decreases the door-to-needle time.

早期体外心脏震波通过抑制TGF-β1-Smad2/3-MMP-9信号通路改善心肌纤维化

目的 探究急性心肌梗死(AMI)大鼠早期经体外心脏震波治疗(CSWT)后心功能和心肌纤维化改善与转化生长因子β1-细胞信号转导分子2/3-基质金属蛋白酶9(TGF-β1-Smad2/3-MMP-9)信号通路的相关性。方法 采用随机数字表法将30只SD大鼠分为sham、AMI、AMI+CSWT、AMI+SB431542和AMI+SB431542+CSWT组,每组各6只。sham组仅开胸,其他4组构建AMI模型。AMI+SB431542组和AMI+SB431542+CSWT组在术后4d行SB431542处理,持续3d。AMI+CSWT组和AMI+SB431542+CSWT组均行9次CSWT[于术后7d开始行CSWT,两次之间间隔1d,能量:0.09m J/mm~2,一个缺血区域共1800震,频率:3Hz(3震/s)]。各组均在术后4d和62d行超声心动图检测左心室射血分数(LVEF)、左心室短轴缩短率(LVFS)、左心室舒张末期容积(LVEDV)和左心室收缩末期容积(LVESV)。术后62d行心脏组织取材,HE染色、Masson染色评估心肌组织病理形态学改变及心肌纤维化程度;于心肌梗死边缘区检测TGF-β1-Smad2/3-MMP-9信号通路相关蛋白表达水平及COL-Ⅰ、COL-Ⅲ蛋白表达水平。结果 (1)术后4d,与sham组相比,AMI、AMI+CSWT、AMI+SB431542和AMI+SB431542+CSWT组的LVEF、LVFS明显降低,LVESV明显扩大(均为P<0.05)。(2)术后62d,与sham组相比,AMI组的LVEF、LVFS明显降低,LVEDV、LVESV明显扩大(均为P<0.05);与AMI组相比,AMI+CSWT组的LVEF、LVFS明显改善,LVEDV、LVESV明显回缩(均为P<0.05);与AMI+CSWT组相比,AMI+SB431542+CSWT组的LVEF、LVFS、LVEDV和LVESV无统计学差异(均为P>0.05)。(3)HE染色显示,AMI组较sham组红色区域排列紊乱、蓝色区域增多;AMI+CSWT组较AMI组红色区域排列整齐、蓝色区域减少,但较sham组蓝染区域增多。(4)Masson染色显示,与sham组相比,AMI组胶原容积分数(CVF)明显升高(P<0.001);与AMI组相比,AMI+CSWT和AMI+SB431542组的CVF明显降低(均为P<0.05);与AMI+CSWT组相比,AMI+SB431542+CSWT组CVF较高,但无统计学差异(P=0.65)。(5)Westernblot结果显示,与sham组相比,AMI组的TGF-β1、Smad3、MMP-9、COL-Ⅰ和COL-Ⅲ表达水平明显升高(均为P<0.05);Smad2水平有升高趋势,但无统计学差异(P=0.40);与sham组和AMI组相比,AMI+CSWT组的TGF-β1、Smad2、Smad3、MMP-9、COL-Ⅰ和COL-Ⅲ表达水平明显降低(均为P<0.05);与AMI+CSWT组相比,AMI+SB431542+CSWT组的TGF-β1、Smad2、Smad3和MMP-9表达水平明显降低,COL-Ⅰ和COL-Ⅲ表达水平明显增加(均为P<0.05)。结论 早期CSWT可改善心功能、抑制心肌纤维化,且与抑制TGF-β1-Smad2/3-MMP-9信号通路相关。

强化胰岛素治疗对急性心肌梗死患者的预后影响

目的系统评价强化胰岛素治疗应用于急性心肌梗死患者的临床疗效和安全性,为改善预后提供参考。方法对Cochrane、Embase、PubMed、中国知网、万方数据知识服务平台、中文科技期刊数据库、CBM数据库自建库至2022年10月的相关文献进行系统检索,以确定比较强化胰岛素治疗和普通胰岛素治疗对急性心肌梗死患者的临床预后影响的随机对照试验。提取每项研究的数据和特征,采用RevMan 5.4软件进行荟萃分析。结果最终纳入8篇文献,共包含726例患者,其中强化胰岛素治疗组372例、普通胰岛素治疗组354例。对各组数据进行荟萃分析显示,强化胰岛素治疗组主要心血管不良事件发生率(RR=0.53,95%CI=0.44~0.64,P<0.001)、全因死亡率(RR=0.51,95%CI=0.33~0.78,P=0.002)、治疗7 d超敏C反应蛋白(WMD=-2.00,95%CI=-2.17~-1.83,P<0.001)均显著低于普通胰岛素治疗组,治疗30 d左心室射血分数(WMD=3.94,95%CI=2.45~5.43,P<0.001)、低血糖事件发生率(RR=2.96,95%CI=1.12~7.83,P=0.030)均显著高于普通胰岛素治疗组,两组经皮冠状动脉介入治疗术后无复流事件差异无统计学意义(RR=0.39,95%CI=0.14~1.13,P=0.080)。结论强化胰岛素治疗可能与急性心肌梗死患者的临床获益相关,但需要更多研究来证实。

血府逐瘀汤对STEMI病人PCI术后炎症指标、再灌注后心功能及生存质量的影响

目的:探讨血府逐瘀汤对ST段抬高型心肌梗死(STEMI)病人经皮冠状动脉介入治疗(PCI)术后炎症指标及再灌注后心功能及生存质量的影响。方法:选取2020年1月1日—2021年12月31日于我院接受PCI治疗的STEMI病人244例作为研究对象,采用计算机随机化法分为研究组和对照组,每组122例。研究组给予血府逐瘀汤+PCI术后常规基础治疗,对照组给予PCI术后常规基础治疗,两组病人均随访6个月。对比两组主要心脑血管不良事件(MACCE)发生情况、心肌梗死多维度量表(MIDAS)评分、美国纽约心脏协会(NYHA)心功能分级、不良反应发生情况、中医临床症状积分、中医证候疗效、左心室重构情况及炎性因子[白细胞介素-6(IL-6)、内皮素-1(ET-1)、一氧化氮(NO)以及基质金属蛋白酶-9(MMP-9)]水平。结果:研究组MACCE总发生率低于对照组,NYHA心功能分级改善情况优于对照组,中医证候疗效优于对照组(P<0.05)。治疗后,两组MIDAS评分均较治疗前降低,且研究组低于对照组(P<0.05)。治疗后,两组中医临床症状积分均较治疗前下降,且研究组低于对照组(P<0.05)。治疗后,两组左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)降低,左室射血分数(LVEF)升高,且研究组LVESD、LVEDD低于对照组,LVEF高于对照组(P<0.05)。治疗后,两组IL-6、ET-1、MMP-9降低,NO升高,且研究组IL-6、ET-1、MMP-9低于对照组,NO高于对照组(P<0.05)。结论:血府逐瘀汤应用于STEMI病人PCI术后能显著提高病人的整体生存质量,降低MACCE发生风险,改善心功能,减轻炎症反应,有利于病人预后。