Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction

BACKGROUND Acute myocardial infarction(AMI)is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium.Timely medical contact is critical for successful AMI treatment,and delays increase the risk of death for patients.Pre-hospital delay time(PDT)is a significant challenge for reducing treatment times,as identifying high-risk patients with AMI remains difficult.This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care,ultimately reducing PDT and improving treatment outcomes.AIM To construct a nomogram model for forecasting pre-hospital delay(PHD)likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk.METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022.The study included 252 patients,with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio.Independent risk factors influencing PHD were identified in the development group,leading to the establishment of a nomogram model for predicting PHD in patients with AMI.The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups.RESULTS Independent risk factors for PHD in patients with AMI included living alone,hyperlipidemia,age,diabetes mellitus,and digestive system diseases(P<0.05).A characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787(95%confidence interval:0.716–0.858)and 0.770(95%confidence interval:0.660-0.879)in the development and validation groups,respectively,demonstrating the model's good discriminatory ability.The Hosmer–Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts(P>0.05),indicating satisfactory model calibration.CONCLUSION The nomogram model,developed with independent risk factors,accurately forecasts PHD likelihood in AMI individuals,enabling efficient identification of PHD risk in these patients.

Progress in diagnosis,treatment and treatment of acute myocardial infarction with traditional C hinese medicine

Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Combining the latest research on the treatment of acute myocardial infarction with traditional Chinese medicine and related literature reports,it summarizes the theories and treatments of traditional Chinese medicine,aiming to provide clinicians with ideas and references in clinical diagnosis and treatment.

The impact analysis of the oxidative stress injury and inflammatory factor level for ticagrelor assisted PCI in the treatment the elderly patients with ST segment elevation acute myocardial infarction

Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total of 100 cases elderly patients with STEMI were selected that they were being treated with PCI. According to the digital list method was divided into the study group and control group, and 50 cases in each group. The control group was treated with PCI and the strong heart, anticoagulation, vasodilation, prevention of infection and other comprehensive treatment of myocardial infarction, the study group were given ticagrelor treatment which was based on the comprehensive treatment of myocardial infarction. The level change were compared that oxidative stress index (MDA), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) activity and inflammatory factor hypersensitive C reactive protein (hs-CRP), N-terminal pro brain natriuretic peptide (NT-proBNP) and interleukin -6 (IL-6) between the two groups in before treatment (T0), treatment with 7 d (T1), 14 d (T2), 30 d (T3).Results:(1)There was no significant difference in serum MDA, GSH-Px and SOD levels between the two groups in the T0. Two groups serum MDA level were higher than theT0, and the GSH-Px and SOD levels were lower than the T0 after operation in the T1.And the serum MDA level were lower than T0, T1, GSH-Px and SOD levels were higher than T0, T1in the T2, T3.The T3 serum MDA level was lower than T2, GSH-Px and SOD levels were higher than T2.Even the serum MDA was significantly lower than the control group T1, T2, T3 and the GSH-Px and SOD were higher than those of the control group T1, T2, T3 at the study groupT1, T2, T3, the difference was statistically significant. (2)There was no significant difference in T0 of the serum hs-CRP, IL-6 and NT-proBNP levels between the two groups. Two groups serum hs-CRP, IL-6 and NT-proBNP level were higher than the T0 after operation in the T1.And the serum hs-CRP, IL-6 and NT-proBNP levels were higher than T0, T1in the T2, T3.The T3 serum hs-CRP, IL-6 and NT-proBNP levels were lower than T2.and that the serum hs-CRP, IL-6 and NT-proBNP levels were significantly lower than the control group T1, T2, T3 at the study groupT1, T2, T3, so the difference was statistically significant.Conclusion:The treatment method will be able to reduce oxidative stress injury and effectively control the inflammatory response that ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI).

Analysis of the risk factors for severity in post endoscopic retrograde cholangiopancreatography pancreatitis: The indication of prophylactic treatments

AIM To determine the risk factors of severe post endoscopic retrograde cholangiopancreatography pancreatitis(s PEP) and clarify the indication of prophylactic treatments.METHODS At our hospital, endoscopic retrograde cholangiopancreatography(ERCP) was performed on 1507 patients from May 2012 to December 2015. Of these patients, we enrolled all 121 patients that were diagnosed with post endoscopic retrograde PEP. Fourteen of 121 patients diagnosed as s PEP were analyzed.RESULTS Forty-one patients had contrast media remaining in the pancreatic duct after completion of ERCP. Seventy-one patients had abdominal pain within three hours after ERCP. These were significant differences for s PEP(P < 0.05). The median of Body mass index, the median time for ERCP, the median serum amylase level of the next day, past histories including drinking and smoking, past history of pancreatitis, sphincter of Oddi dysfunction, whether emergency or not, expertise of ERCP procedure, diverticulum nearby Vater papilla, whether there was sphincterotomy or papillary balloon dilation, pancreatic duct cannulation, use of intraductal ultrasonography enforcement, and transpapillary biopsies had no significant differences with s PEP.CONCLUSION Contrast media remaining in the pancreatic duct and the appearance of abdominal pain within three hours after ERCP were risk factors of s PEP.

Treatment of severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome after primary coronary intervention for acute inferior wall myocardial infarction: A case report

BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB,followed by vomiting. His hemoglobin level dropped from 15.3 g/d L to 9.7 g/d L. In addition to blood transfusion and a gastric acid inhibition treatment,early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding.

Risk Factors of First Acute Myocardial Infarction: Comparison of Elderly and Non-Elderly: A 24-Year Study

Although risk factors of Ischemic Heart Disease (IHD) are well known, knowledge about the distribution of these risk factors in different subgroups of patients can be used for designing preventive programs. The aim of this study was to assess differences of prevalence of IHD risk factors in elderly and non-elderly patients in their first Acute Myocardial Infarction (AMI). In this retros-pective study, elderly (age > 65;n = 1060) and non-elderly (age ≤ 65;n = 2228) patients with first AMI who were admitted into four teaching hospitals in Tehran between 1982 and 2005 were recruited. Risk factors containing male gender, systolic and diastolic hypertension (HTN), diabetes, hypertriglyceridemia, hypercholesterolemia, smoking and family history of IHD were compared between the two groups. Among different risk factors, diabetes and systolic HTN were more common in elderly than their non-elderly counterparts, and male gender, smoking, family history of IHD and dyslipidemia were more common in non-elderly patients than elderly ones (p < 0.05 for all comparison). Diastolic HTN showed no significant difference between the two groups. Findings of this study, stating difference of prevalence of risk factors in two elderly and non-elderly groups, can be used by health policy makers to conduct preventive programs for AMI in this country.

Risk Factors and Relation Between Clinical,Biochemical Marker and Stenosis Extent of Coronary Artery in Young Adults With Acute Myocardial Infarction

Objectives To analyze risk factors and the relation between clinical, biochemical marker and the stenosis extent of coronary artery in patients below the age of 45 years with acute myocardial infarction （AMI）. Methods A retrospective investigation was performed on 92 patients below the age of 45 with AMI at the First Affiliated Hospital of Medical School of Xi′an Jiaotong University in 2003-2007. The etiology, morbidity, risk factors, clinical features and results of coronary angiography were studied. Various clinical and biochemical markers were assessed to find out what were associated with the stenosis extent of coronary artery. Meanwhile, the differences between one-vessel disease （group A） and two-vessel or multi-vessel disease （group B） patients with AMI were comparatively analyzed. Results Risk factors analysis revealed that a history of cigarette smoking, metabolic disorders and abusive drinking were mainly found in young AMI patients below the age of 45 years, and metabolic disorder mainly consists of decreased high-density lipoprotein cholesterol （HDL-C） and hypertriglyceridemia. AMI in patients below the age of 45 years account for 10.3% of all AMI. Angiographically, the incidence of one-vessel affected was most frequent in the young adults （73.75 %）. The most committed vessel was LAD （80.00 %）. A higher incidence with history of hypertension and diabetes or impaired glucose tolerance was found in group B, but a history of preceding angina 1 month earlier was more frequently found in group A. Improved Genisi scores of coronary angiography was lower in group A than in group B（7.49±3.63 vs 15.08±6.08）. Correlation analysis showed that log（LDL-C/HDL-C）（r= 0.238, P= 0.037）, TC/HDL-C （r= 0.232, P= 0.046） were directly correlated with angiographic scores, and HDL-C（r= -0.202, P= 0.042）was inversely correlated. Multielement gradual linear regression analysis showed log（LDL-C/HDL-C）, TC/HDL-C were associated with the extent of stenosis of coronary artery. Furthermore, the correlation was linear dependence. Conclusions A history of cigarette smoking, metabolic disorders and abusive drinking are mainly found in young patients with AMI under the age of 45 years. Bad life style is the main motivator. The main cause is atherosclerosis（95%）. A higher incidence of history of hypertension and diabetes or impaired glucose tolerance is associated with multi-vessel affected,log（LDL-C/HDL-C）, TC/HDL-C are linear dependent on the extent of stenosis of coronary artery. Thus changing of bad life style （stop smoking et al）, improving of lipoprotein profile are more important for the prevention and treatment of AMI in young adults.

Risk Stratification with Serum Cardiac Troponin I in Acute Myocardial Infarction on Admission

Objective To assess the prognostic significance of serum cardiac troponin I (cTnI) concentration in patients with acute myocardial infarction on admission. Methods Serum samples of 108 patients with established AMI were collected on admission for measuring cTnI and were grouped according to the intervals between the onset of chest pain and admission. Results In each of these groups, the serum cTnI concentrations in patients died after admission were significantly higher than those who survived (all P<0.05). Conclusions A higher serum cTnI concentration on admission in patients with AMI was associated with an increased risk of subsequent cardiac death during hospitalization.

Factors influencing prehospital delay for patients with acute myocardial infarction

Objective To investigate the influencing factors for prehospital delay in patients with acute myocardial infarction (AMI). Methods A total of 807 consecutive patients with AMI who presented to the emergency department of Beijing Anzhen Hospital were analyzed. The influence of several potential risk factors on the prehospital delay time (PDT) was evaluated by comparing patients admitted more than 2 hours after onset of chese pain with those admitted within 2 hours after onset. Results Among 807 patients, 402 came to the hospital within 2 hours while the others arrived at the hospital after 2 hours. The median PDT was 130 min. Among the potential variables, advanced age, history of diabetes mellitus, occurrence of symptom at night and use of emergency medical service significantly affected PDT by multivariate analysis. Conclusion Interventions aimed at reducing the prehospital delay in AMI should primarily focus on the awareness of the risk and help-seeking behavior of patients.

Association of psychological risk factors and acute myocardial infarction in China： the INTER-HEART China study

Background Most data about psychological factors relating to acute myocardial infarction （AMI） were obtained from studies carried out in western countries. Results from small descriptive cross-sectional studies in China were inconclusive. The aim of this study was to explore possible associations between psychological risk factors and AMI among the Chinese population with a large-scale case-control study.Methods This study was part of the INTER-HEART China study, itself part of the large international INTER-HEART study of cardiovascular risk factors. In this case-control study, 2909 cases and 2947 controls were recruited from 17 cities.Psychological stress, negative life events, depression and controllability of life circumstances were assessed.Results Cases reported more psychological stress at home or work and odds ratios （ORs） were 3.2 （95% CI 2.1-4.9）for permanent stress and 2.1 （95% CI 1.5-2.8） for several periods of stress respectively. More cases experienced depression compared with controls （19.6% vs. 9.3%） and ORs were 2.2 （95% CI 1.9-2.6）. Subjects with 1, 2 and 3 or more depressive symptoms had increased risk of AMI by 2.1, 2.2 and 2.6 fold, respectively, i.e., more depressive symptoms were associated with higher risks of AMI （P for trend ＜0.0001）. Women had a greater risk of AMI from depression （OR 3.0, 95% CI 2.2-4.0） compared to men （OR 2.0, 95% CI 1.6-2.4）, P for interaction =0.0364. Negative life events in subjects were associated with increased risk of AMI, OR 1.7 （95% CI 1.4-2.0） for one event and 1.8 （95% CI 1.3-2.4） for two or more events. High levels of controllability of life circumstances reduced the risk for AMI （OR 0.8, 95%CI 0.7-1 .0）.Conclusions Several psychological factors were closely associated with increased AMI risk among Chinese population.Psychological stress had a greater AMI risk in men but depression was more significant among women.

Twenty-year trends in major cardiovascular risk factors in hospitalized patients with acute myocardial infarction in Beijing

Background Hypertension, diabetes mellitus, hypercholesterolaemia and current smoking are the strongest modifiable cardiovascular risk factors for acute myocardial infarction （AMI）. We examined their changing trends over the last 20 years. Methods The clinical data of 3498 patients hospitalized in Peking University People＇s Hospital with AMI from 1991 to 2010 were used. Information was collected regarding to patients＇ demographic data, cardiovascular risk factors （hypertension, diabetes mellitus, hypercholesterolemia and current smoking）. To assess trends over time in the prevalence of risk factors, we categorized patients into four groups （1991 to 1995, 1996 to 2000, 2001 to 2005 and 2006 to 2010）. Results Highly significant increases were observed in the prevalence of hypertension from 40.8% to 55.6% for males and from 58.0% to 69.0% for females; and diabetes mellitus from 12.9% to 30.8% for males and from 23.0% to 42.3% for females. Similarly, the prevalence of hypercholesterolaemia decreased from 53.1% to 30.7% for males and from 57.0% to 44.0% for females. The prevalence of current smoking decreased in females from 29.0% to 11.1%, but remained unchanged in males. In addition, the proportion of patients with more than three modifiable risk factors increased from 19.0% to 27.1% and the age at onset of AMI extended to younger as well as older individuals. Conclusions The prevalence of hypertension and diabetes mellitus are still increasing in patients with AMI in Beijing and although the prevalence of hypercholesterolaemia and current smoking decreased, high clustering of risk factors were commonly present. These adverse trends show a compelling need for more effective management of cardiovascular risk factors.

Among the risk factors of myocardial infarction, anthropometry has no association: A case control study in the central region of Sri Lanka

Background: In the face of rising incidence of cardiovascular disease in the globe, the associated risk factors could be country or area specific. This study aimed to identify the important risk factors of myocardial infarction (MI) prevailing in the Kandydistrict of Sri Lanka. Methods: In a case control design, the cases were recruited from the Coronary Care Unit, General Hospital Kandy, with the diagnosis of myocardial infarction. Matched controls were selected from the Out Patient Department with other ailments, unrelated to cardiovascular diseases. Results: There were 205 cases and 197 controls with the mean age of 56 years (SD ± 8.4 years) and 54 years (SD ± 9.8 years) respectively with male: female ratio of 1:0.2. In analysis, hypertension (OR = 5.09, CI = 2.64 - 9.83), type 11 diabetes (OR = 3.45, CI = 1.90 - 6.10), smoking (OR = 1.95, CI= 1.44 - 2.65) and high LDL cholesterol levels (OR = 1.06, CI = 1.04 - 1.06) were identified as the independent risk factors of myocardial infarction. However, the anthropometric measurements, waist hip ratio (OR = 0.64, CI = 0.33 - 1.34) and body mass index ≥ 25 (OR = 0.75, CI = 0.46 - 1.22) did not show an association with myocardial infarctions. Conclusions: Anthropometric measurements did not qualify as risk factors of myocardial infarction in the local setting even though hypertension, diabetes, smoking and high LDL levels showed a significant association in par with the established data.

Effect of recombinant human brain natriuretic peptide on serum inflammatory factors, neuroendocrine hormones and cardiac function in patients with acute myocardial infarction complicated with heart failure

Objective:To investigate the effect of recombinant human brain natriuretic peptide (BNP) on inflammatory factors, neuroendocrine hormones and cardiac function indexes in patients with acute myocardial infarction complicated with heart failure.Methods:A total of91 cases of acute myocardial infarction with heart failure patients were divided into the control group (n=44) and observation group (n=47) according to the random data table, two groups of patients were given conventional treatment, based on this, the control group was given intravenous infusion of Nitroglycerin Injection treatment, the observation group received intravenous injection of recombinant human brain natriuretic peptide treatment, compared serum inflammatory factors, neuroendocrine hormone and cardiac function and other indexes of two groups before and after treatment.Results: there was no significant difference between the two groups before treatment. After treatment, the levels of TNF-α, hs-CRP, IL-6, MCP-1, LVESD and LVEDD in the two groups were significantly lower than those within the group before treatment, and the observation group was significantly lower than the control group;The two groups after treatment LVEF levels were significantly higher than those in the group before treatment, and the observation group was significantly higher than that of control group;the observation group after treatment PRA, Ang II and ALD and NE levels were significantly lower than those before treatment, and was significantly lower than the control group after treatment, the difference was significant, PRA, Ang, ALD and NE levels of control group before and after the treatment was no significant difference.Conclusion:recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction with heart failure can effectively reduce the serum inflammatory factors and neuroendocrine hormone levels, improve heart function, and have a certain clinical value.

A Case of Colon Cancer Surgery Complicated with Acute Myocardial Infarction

Objective:To investigate the treatment and prevention of acute myocardial infarction after colon cancer surgery.Methods:A patient with acute anterior myocardial infarction who underwent stent implantation in the Seventh Affiliated Hospital,Sun Yat-sen University in 2017 was selected as the subject.The patient was admitted to the emergency department for stent implantation and took antiplatelet and lipid regulating drugs orally on time after the operation.The patient also had a history of colon cancer.The lesion was resected,and the complication after operation was acute myocardial infarction.After active and effective treatment and intervention,the treatment effect of the patient was analyzed.Results:Urgent PTCA was performed,and 0.5 mg Tirofiban was injected into the coronary artery.The results of angiography showed that the blood flow of anterior descending branch recovered to grade 2.Conclusion:The condition of patients with myocardial infarction after colon cancer surgery changes rapidly.Surgery combined with drug treatment can achieve a good prognosis,reduce mortality,and improve patients’cardiac function.

Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction： A Matched Case-control Study

Background： Left ventricular thrombus （LVT） is reported to be a common complication in acute myocardial infarction （AMI） patients. And it has the potential to cause systemic embolism. This retrospective study was to present the current situation of LVT in clinical practice, as well as to evaluate the clinical characteristics and the risk factors of LVT alter AMI. Methods： LVT cases （n = 96） were identified from 13,732 AMI （non-ST elevation myocardial infarction was excluded） patients in Fuwai Hospital＇s electronic medical records system from January 2003 to January 2013. The controls （n = 192） were gender- and age-matched AMI patients without LVT during this period. A conditional logistic regression （fitted by the Cox model） was performed to identity the independent risk factors. Results： The incidence of LVT after AMI was 0.7%. Univariate analysis indicated that the anterior myocardial infarction （especially extensive anterior myocardial infarction）, lower left ventricular ejection traction （LVEF）, LVEF ≤40%, severe regional wall motion abnonnalities （RWMA）, pericardial effusion, and left ventricular aneurysm were all related to LVT after AMI. The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF （odds ratio （OR） = 0.891, 95% confidence interval （CI）： 0.828-0.960）, extensive anterior myocardial infarction （OR = 6.403, 95% CI： 1,769~3.169）, severe RWMA （OR = 7.348, 95% （7：1.32340.819）. and left ventricular aneurysm （OR = 6.955.95% CI： 1.673-28.921 ）. Conclusions： This study indicated that lower LVEF. extensive anterior myocardial infarction, severe RWMA, and left ventricular aneu,ysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.

Acute myocardial infarction in a young man with ankylosing spondylitis: A case report

BACKGROUND Ankylosing spondylitis(AS)is a chronic progressive inflammatory disease that mainly affects the spine and sacroiliac joints.To the best of our knowledge,AS with acute myocardial infarction(AMI)has rarely been reported.Here,we report an unusual case of AS with AMI in a young patient.CASE SUMMARY A 37-year-old man was admitted to the Department of Rheumatology and Immunology of our hospital on March 14,2020,for low back pain.Further evaluation with clinical examinations,laboratory tests,and imaging resulted in a diagnosis of AS.Treatment with a non-steroidal anti-inflammatory drug and a tumor necrosis factor inhibitor partially improved his symptoms.However,his back pain persisted.After 6 wk of treatment,he was admitted to the emergency room of another hospital in this city for sudden-onset severe chest pain consistent with a diagnosis of AMI.Angiography revealed severe narrowing of the coronary arteries.Surgical placement of two coronary stents completely relieved his back pain.CONCLUSION AS can cause cardiovascular diseases,including AMI.It is important to consider the cardiovascular risks in the management of AS.

Patient Delay in Patients With ST-elevation Acute Myocardial Infarction

Objectives To examine patient delay (PD) in seeking treatment among patients with ST-elevation myocardial infarction (STEMI) and to identify factors influencing PD. Methods patients with STEMI were divided into two groups based on PD: Short PD group (PD ≤ 60 minutes after onset of symptoms) and long PD group ( > 60 minutes after symptom onset). A questionnaire developed to assess demographic characteristics, clinical factors and psychological factors. Patients were interviewed within 72 hours of admission to 2 hospitals. Results 329 consecutive confirmed STEMI patients (Mean age 61years; 72.5% men) with a median PD of 90 min and a pre-hospital delay time 170 min were studied, PD was less than 1 hours in 47.4% of patients, while more than 1 hours in 52.6%, In univariate analyses, patients with short PD were witness onset, progress course of symptom, severe pain, death anxiety, knowing AMI as a deadly disease and its presentation, taking the symptom seriously. Patients with longer PD were age ≥65 year, nocturnal onset, experienced their symptoms at home, gradual onset, ’waited to see whether symptoms disappeared’, ’worried about troubling others’, ’took pain medication’ and preinfarction angina. A stepwise multiple regression analysis further suggested that the following inde-pendent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): taking pain medication (15.97; 1.70～149.8 ), wanting to wait and see (6.46; 1.92～21.74), not wanting to bother anybody (6.42; 2.87～14.34), preinfarct angina (2.73; 1.20～6.19), age ≥65 years (2.51; 1.15～5.48), gradual onset (2.40; 1.05～5.44), severe pain(0.38, 0.17～0.85), witness onset (0.27, 0.10～0.70), taking symptoms seriously (0.019; 0.08～0.46). Conclusions Age ≥65 years, gradual onset, witness onset, severe pain, preinfarct angina, emotional responses and coping strategies are the independent factors associated with patient delay or decision time in patients with AMI. Emotional responses and coping strategies are the major determinants of patient delay. Modification of these emotional factors might best be achieved by patients and public education.

Impact of statin usage patterns on outcomes after percutaneous coronary in-tervention in acute myocardial infarction：Korea Working Group on Myocar-dial Infarction registry （KorMI） study

在心肌的梗塞(STEMI ) 是的尖锐圣片断举起以后的 statin 使用的 BackgroundThe 利益然而，很好证实预定 statin 管理的影响没被阐明。这研究的目的在经皮的冠的干预(一种总线标准) 以后集中了于早临床的结果学习包括了的心肌的梗塞登记(KorMI ) 上的朝鲜工作组的 .MethodsThis 分析 3,584 个 STEMI 病人(吝啬的年龄， 63 &#x000b1；13 年；男性， 2,684， 74.9%) 从 2008 年 1 月经历一种总线标准到 2009 年 6 月。主要不利心脏的事件的率(向：所有原因死亡，周期性的 MI，和目标损害 revascularization ) 在根据 statin 治疗预定组织的病人之中被比较：我，在期间并且在住院以后(n = 2,653， 74%) ；II，仅仅在住院期间(n = 309， 8.6%) ；III，仅仅在分泌物以后(n = 157， 4.4%) ；并且 IV，没有 statin 治疗(n = 465， 13%) 。吝啬的后续持续时间是 234 &#x000b1；statin 的 113 个 days.ResultsMultivariate 因素在住院期间使用包括的优先的 statin 使用，多重 diseased 容器，在心肌的梗塞流动等级 III 的最后的 thrombolysis，和低密度的脂蛋白胆固醇水平。在 6 月的后续，组 III 和 IV 有最高的向率(2.3% ， 3.9% ， 5.1% ，和 4.9% 为组 I-IV，分别地 P = 0.004 ) 。在为 confounders 调整以后，组 II-IV 比组有更高的向风险我[危险比率(HR ) ：3.20， 95% 信心间隔(95%CI ) ：1.31-7.86， P = 0.011；HR：3.84， 95%CI：1.47-10.02， P = 0.006；并且 HR：3.17， 95%CI：1.59-6.40， P = 0.001；分别地] 基于国家注册表数据库， .ConclusionsThis 学习早显示出早、连续的 statin 治疗 improvs 在在真实世界的临床的实践的一种总线标准以后的 STEMI 病人的结果。

A Comparative Study of Risk Factors and Prognosis in Young and Elderly Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of young patients with acute STEMI.Methods:Patients initially diagnosed with STEMI in the 920"Hospital of Joint Logistic Support Force of PLA from January 1,2018 to December 31,2022 were retrospectively enrolled in this study.A total of 235 STEMI patients aged≤45 years old and 532 STEMI patients aged≥65 years old were screened.The baseline characteristics,laboratory indicators,clinical characteristics,coronary angiography,SYNTAX score and major adverse cardiovascular events(MACE)during 1-year follow-up were analyzed and compared.Results:A total of 767 STEMI patients were enrolled,including 235 in the young group and 532 in the elderly group.Among the STEM patients in the young group,224 cases were male,and smoking and drinking were common.Compared with the elderly group,the young group had shorter hospital stays and more family history of ischemic heart disease(IHD).The level of low-density lipoprotein in the young group was higher than that in the old group,while the level of high-density lipoprotein in the young group was lower than that in the old group.The level of high uric acid and homocysteine in the young group was significantly higher than that in the old group.The main cause of STEMI in the young group was fatigue,and the most common symptom was angina pectoris.Coronary angiography showed that single vessel disease was more common in the young group than in the elderly group,and the lesion in the young group was the left anterior descending artery.The SYNTAX score was significantly lower in the young group than in the elderly group according to the anatomical characteristics of coronary artery disease.In the forest plot,diabetes mellitus and a family history of IHD showed a trend of major adverse cardiovascular events(MACE)in both groups.Conclusion:Males,smokers,alcohol drinkers and family history of ischemic heart disease are more common in young patients.Common risk factors include fatigue,hyperuricemia,hyperlipidemia and so on.In addition,age itself is an independent risk factor.Management of diabetes,hyperuricemia,and homocysteine levels is essential to reduce the incidence of cardiovascular events in young patients.By controlling these factors,the incidence of young patients with acute STEMI can be effectively prevented and the corresponding prevention and treatment basis can be provided.

Influence of atrial fibrillation on acute myocardial infarction

Atrial fibrillation is an increasingly common significant arrhythmia with potentially serious outcomes. Myocardial infarction is a common consequence of atherosclerosis and coronary artery disease. When the two conditions occur together, the consequences can be compounded. This article briefly reviews some of the potentials for the relationship.