Acute myocardial infarction (AMI) is rare in young adults. The management of these patients is considered as a clinical challenge. We report the case of a 26-year-old man who was presented to the Emergency Room of Aff...Acute myocardial infarction (AMI) is rare in young adults. The management of these patients is considered as a clinical challenge. We report the case of a 26-year-old man who was presented to the Emergency Room of Affiliated Hospital of Guilin Medical University with an acute onset of chest pain. Initially electrocardiogram (ECG) with no evidence of ST-segment abnormalities but QT prolongation a signal of sudden cardiac death, 20 minutes later, it revealed ST-segment elevation myocardial infarction (STEMI). Coronary angiography (CAG) demonstrated left main coronary artery occlusion. AMI was diagnosed based on clinical symptom, elevated cardiac biomarkers, electrocardiographic dynamic monitoring and CAG. The awareness of chest pain as possible underlying AMI symptom—especially in young patients presenting with QT prolongation—is crucial for clinical treatment, as a missed diagnosis can worsen the patient’s further prognosis. In addition, reperfusion arrhythmia is a challenge to short-term outcomes of young patients with AMI, so it is necessary to make preoperative risk stratification.展开更多
To examine the procoagulant effects of thrombolytic agent on h emostasis and study the role of hemostatic markers as predictors of clinical outcomes. Methods. In the present study, eighteen patients with acute m...To examine the procoagulant effects of thrombolytic agent on h emostasis and study the role of hemostatic markers as predictors of clinical outcomes. Methods. In the present study, eighteen patients with acute myocardial in farction(AMI) received 1.5 or 2.0 million U nonspecific urokinase(UK), or 70～80 mg fibrin specific recombinant tissue plasminogen activator(rt PA)and did not use heparin until 8 hours after intravenous injection of the above agents. Eig ht patients with AMI and without thrombolytic therapy were enrolled as controls. Coagulant and thrombolytic activity markers included thrombin antithrombin Ⅲ complex (TAT), D dimer, fibrinogen (Fg), FMPV/Amax. All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic a gents respectively. Results. Molecular marker of thrombin generation——TAT showed an activated coa gulant state immediately after thrombolytic therapy. Level of TAT showed no sign ificant changes between every two observed phases in controls. However, level of TAT increased significantly from 4.95±1.75μg/L ( 4.63±1.37μg/L) to 14.71±3 .31μg/L ( 14.25±2.53μg/L) before and immediately after administration of thro mbolytic agents UK(or rt PA). There was significant difference between level of serum TAT of patients with and without thrombolytic therapy (P< 0.05). Patients achieving clinical reperfusion had lower TAT level than those failing in thromb olytic therapy, and higher FMPV/Amax level than controls. D dimer, a surrogate of thrombolytic activity increased markedly and Fg significantly declined afte r thrombolytic therapy(P< 0.05).Conclusions. Thrombin generation occurred in plasma in response to excess fibri nolysis induced by thrombolytic therapy. Both urokinase and rt PA had procoagul ant action. This transient activation of the coagulant system might contribute t o early reocclusion. These data provided the theoretical support for simultaneou s administration of anticoagulant therapy with thrombolytic agents. These result s also suggested that TAT might be useful in predicting clinical outcomes of p atients treated with thrombolytic therapy for AMI.展开更多
目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原...目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原则分为对照组和观察组,各组43例。两组均采取PCI治疗,术中给予普通肝素钠、替罗非班,对照组注入rhPro-UK进行常规溶栓。观察组由犯罪血管远端到近端注入rhPro-UK进行逆行溶栓。比较两组术后心肌梗死溶栓试验(TIMI)血流分级、2 h ST段回落率(STR)、冠脉无复流及慢血流(NR/SF)发生率,术后住院期间B型利钠肽(BNP)、肌钙蛋白(cTnI)、左室射血分数(LVEF),随访3个月,比较两组TIMI大出血事件及主要不良心血管事件(MACEs)发生率。结果观察组PCI术后TIMI血流分级优于对照组,STR回落率高于对照组,NR/SF发生率低于对照组(P<0.05);观察组术后住院期间BNP峰值、cTnI峰值均低于对照组,LVEF峰值高于对照组(P<0.05);两组随访期间均未发生TIMI大出血,观察组MACEs发生率(心衰再住院2例)低于对照组(心源性死亡1例,心衰再住院8例),差异有统计学意义(P<0.05)。结论替罗非班联合重组人尿激酶原预处理逆行溶栓可显著改善STEMI患者PCI术后血流复流情况及左室射血功能,降低冠脉无复流及慢血流与不良心血管事件等发生率,且不增加出血风险。展开更多
Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～8...Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～80) with AMIunderwent 24 hours , Holter monitoring within 6 hours after the symptom onset- The changes of STsegment was observed continually and was compared with the results of coronary arteries angiography- Results : ①In the patients who had occluded IRA, STsegmentremained elevated with a tendency to decline- ②In those who had successful reperfusion ,STsegment reduced rapidly after reperfusion and then kept stable- ③Intermittent fluctuating up and down of STsegment was observed com monly during the first 24 hours in all AMIpatients ,especially in the earliertime after successfulthrombolysis- Conclusion : The dynamic changes of IRA between opening and occluding were showed in early AMI- The continued monitoring of STsegment can be used to evaluate the dynamic changes of IRA-展开更多
文摘Acute myocardial infarction (AMI) is rare in young adults. The management of these patients is considered as a clinical challenge. We report the case of a 26-year-old man who was presented to the Emergency Room of Affiliated Hospital of Guilin Medical University with an acute onset of chest pain. Initially electrocardiogram (ECG) with no evidence of ST-segment abnormalities but QT prolongation a signal of sudden cardiac death, 20 minutes later, it revealed ST-segment elevation myocardial infarction (STEMI). Coronary angiography (CAG) demonstrated left main coronary artery occlusion. AMI was diagnosed based on clinical symptom, elevated cardiac biomarkers, electrocardiographic dynamic monitoring and CAG. The awareness of chest pain as possible underlying AMI symptom—especially in young patients presenting with QT prolongation—is crucial for clinical treatment, as a missed diagnosis can worsen the patient’s further prognosis. In addition, reperfusion arrhythmia is a challenge to short-term outcomes of young patients with AMI, so it is necessary to make preoperative risk stratification.
文摘To examine the procoagulant effects of thrombolytic agent on h emostasis and study the role of hemostatic markers as predictors of clinical outcomes. Methods. In the present study, eighteen patients with acute myocardial in farction(AMI) received 1.5 or 2.0 million U nonspecific urokinase(UK), or 70～80 mg fibrin specific recombinant tissue plasminogen activator(rt PA)and did not use heparin until 8 hours after intravenous injection of the above agents. Eig ht patients with AMI and without thrombolytic therapy were enrolled as controls. Coagulant and thrombolytic activity markers included thrombin antithrombin Ⅲ complex (TAT), D dimer, fibrinogen (Fg), FMPV/Amax. All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic a gents respectively. Results. Molecular marker of thrombin generation——TAT showed an activated coa gulant state immediately after thrombolytic therapy. Level of TAT showed no sign ificant changes between every two observed phases in controls. However, level of TAT increased significantly from 4.95±1.75μg/L ( 4.63±1.37μg/L) to 14.71±3 .31μg/L ( 14.25±2.53μg/L) before and immediately after administration of thro mbolytic agents UK(or rt PA). There was significant difference between level of serum TAT of patients with and without thrombolytic therapy (P< 0.05). Patients achieving clinical reperfusion had lower TAT level than those failing in thromb olytic therapy, and higher FMPV/Amax level than controls. D dimer, a surrogate of thrombolytic activity increased markedly and Fg significantly declined afte r thrombolytic therapy(P< 0.05).Conclusions. Thrombin generation occurred in plasma in response to excess fibri nolysis induced by thrombolytic therapy. Both urokinase and rt PA had procoagul ant action. This transient activation of the coagulant system might contribute t o early reocclusion. These data provided the theoretical support for simultaneou s administration of anticoagulant therapy with thrombolytic agents. These result s also suggested that TAT might be useful in predicting clinical outcomes of p atients treated with thrombolytic therapy for AMI.
文摘目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原则分为对照组和观察组,各组43例。两组均采取PCI治疗,术中给予普通肝素钠、替罗非班,对照组注入rhPro-UK进行常规溶栓。观察组由犯罪血管远端到近端注入rhPro-UK进行逆行溶栓。比较两组术后心肌梗死溶栓试验(TIMI)血流分级、2 h ST段回落率(STR)、冠脉无复流及慢血流(NR/SF)发生率,术后住院期间B型利钠肽(BNP)、肌钙蛋白(cTnI)、左室射血分数(LVEF),随访3个月,比较两组TIMI大出血事件及主要不良心血管事件(MACEs)发生率。结果观察组PCI术后TIMI血流分级优于对照组,STR回落率高于对照组,NR/SF发生率低于对照组(P<0.05);观察组术后住院期间BNP峰值、cTnI峰值均低于对照组,LVEF峰值高于对照组(P<0.05);两组随访期间均未发生TIMI大出血,观察组MACEs发生率(心衰再住院2例)低于对照组(心源性死亡1例,心衰再住院8例),差异有统计学意义(P<0.05)。结论替罗非班联合重组人尿激酶原预处理逆行溶栓可显著改善STEMI患者PCI术后血流复流情况及左室射血功能,降低冠脉无复流及慢血流与不良心血管事件等发生率,且不增加出血风险。
文摘Objective : To evaluate the dynamic change ofinfarct related arteries (IRA) with continued monitoring of STsegmentin early acute myocardial infarction (AMI)- Methods :61 patients (46 males and 15 females , aged 39 ～80) with AMIunderwent 24 hours , Holter monitoring within 6 hours after the symptom onset- The changes of STsegment was observed continually and was compared with the results of coronary arteries angiography- Results : ①In the patients who had occluded IRA, STsegmentremained elevated with a tendency to decline- ②In those who had successful reperfusion ,STsegment reduced rapidly after reperfusion and then kept stable- ③Intermittent fluctuating up and down of STsegment was observed com monly during the first 24 hours in all AMIpatients ,especially in the earliertime after successfulthrombolysis- Conclusion : The dynamic changes of IRA between opening and occluding were showed in early AMI- The continued monitoring of STsegment can be used to evaluate the dynamic changes of IRA-
