Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.

Correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction

Objective:To analyze the correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Methods:80 patients with acute ST-elevation myocardial infarction were divided into high iron group (serum iron≥8.95μmol/L) (n=43) and low iron group (serum iron<8.95μmol/L) (n=37) according to serum iron levels, differences in myocardial injury markers, ventricular remodeling indexes and pump failure-related indexes on admission were compared between two groups of patients, and the correlation of serum iron levels with myocardial damage and pump failure in patients with acute ST-elevation myocardial infarction was further analyzed. Results:Serum myocardial injury markers troponin I (cTnI), creatine kinase isoenzyme (CK-MB), myoglobin (Myo), ischemia modified albumin (IMA) and hydroxybutyrate dehydrogenase (HBDH) content of high iron group on admission were significantly lower than those of low iron group (P<0.05);left ventricular posterior wall thickness (LVPWT), left ventricular end-systolic interventricular septal thickness (IVST), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), end-systolic volume index (ESVI), end-diastolic volume index (EDVI), and the left ventricular mass index (LVMI) levels under color Doppler ultrasound were lower than those of low iron group (P<0.05);serum N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, adiponectin (APN), soluble P-selectin (sP-selectin) and Copeptin content were lower than those of low iron group (P<0.05). Pearson test showed that serum iron level was directly correlated with the degree of myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Conclusions:Low serum iron levels is one of key factors causing severe cases and pump failure in STEMI patients, and early iron supplementation is expected to improve outcomes in STEMI patients with iron deficiency.

Effects of rh BNP after PCI on non-invasive hemodynamic in acute myocardial infarction patients with left heart failure

Objective: To investigate the effects of exogenous recombinant human brain natriuretic peptide(rh BNP) after primary percutaneous coronary intervention(PCI) on non-invasive hemodynamic in acute myocardial infarction patients with left ventricular failure. Methods: A number of 96 acute myocardial infarction patients accompanied with heart failure after PCI hospitalized in the People's Hospital of Sanya during February 2012 to October 2015 were selected. They were randomly divided into the therapy group(n = 50) and control group(n = 46). On the basis of routine treatment, patients in the therapy group were treated with intravenous rh BNP(1.5 μg/kg was intravenous injection with uniform speed of 3 min, followed by continuous infusion 0.007 5 μg/kg·min for 72 h), while the control group received conventional treatment. Bio Z-2011 non-invasive hemodynamic real-time monitoring system was used to monitor the hemodynamic parameters changes and the leves of plasma pro-BNP, serum creatinine, serum potassium, serum sodium and urine volume of each group before and after treating for 30 min, 1 h, 3 h, 6 h, 12 h, 24 h, 48 h, 72 h. Results: Patients in the therapy group showed no effect on heart rate, while after 30 min of intravenous injection of rh BNP, CO, CI, SV, and SI increased significantly and LVET and TFC reduced at the same time, which had certain effect on blood pressure(SBP/DBP). Compared with the control group, the therapy group showed a faster and more effective improvement on haemodynamics. Conclusions: Acute myocardial infarction patients complicated with left heart failure after primary PCI can significantly improve hemodynamics by treating with rh BNP.

Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI

BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses.

Combination therapy reduces the percutaneous coronary intervention acute myocardial infarction incidence of no-reflow after primary in patients with ST-segment elevation

Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.

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).

Application of N-terminal pro-brain natriuretic peptide concentration and the Global Registry of Acute Coronary Events risk score to predict major adverse cardiac events in patients with ST-elevation myocardial infarction after PCI

Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain natriuretic peptide(NT-pro-BNP)concentration and global acute coronary event register(GRACE)risk score in the prognosis of ST-segment elevation myocardial infarction(STEMI)patients,to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of STEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 118 confirmed STEMI patients who had received acute percutaneous coronary intervention(PCI).Thirty patients with STEMI were included in the major cardiac adverse events(MACEs)group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).The linear correlation analysis confirmed the relationship between NT-proBNP concentration and GRACE score.Results After adjustment for sex,history of current smoking,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that NT-proBNP concentration and GRACE score were the independent predictors for MACEs in STEMI patients who received PCI.Linear regression analysis showed that the level of NT-pro-BNP was positively correlated with GRACE score(r=0.612,P=0.000).The area under the curve(AUC)for GRACE,NT-pro-BNP and their combination were 0.757,0.723 and 0.782,respectively.Conclusions In a one-year follow-up,the concentration of NTpro-BNP and GRACE score were valuable of prediction for MACEs in STEMI patients who received PCI.In addition,NT-pro-BNP concentration was positively correlated with GRACE score.Additionally,the concentration of NT-pro-BNP could moderately enhance the GRACE score prediction of 1-year MACEs in STEMI patients who received PCI.

Short-term Prognosis of Fragmented QRS Complex in Patients with Non-ST Elevated Acute Myocardial Infarction

Background：There remains significant debate as to the relationship between fragmented QRS （fQRS） complexes on electrocardiogram （ECG） and acute myocardial infarction （AMI）.Few studies have reported on this relationship in non-ST elevated AMI （NSTEMI）,and thus,we attempt to assess this relationship and its potential short-term prognostic value.Methods：This was a single-center,observational,retrospective cohort study.A total of 513 consecutive patients （399 men,114 women） with NSTEMI within 24 h who underwent coronary angiography at our department,between January 1,2014,and December 31,2014.Patients were divided into 2 groups according to the presence or absence of fQRS complex on the admission ECG.fQRS complexes were defined as the existence of an additional R＇ or crochetage wave,notching in the nadir of the S wave,RS fragmentation,or QS complexes on 2 contiguous leads.All patients were followed up for 6 months,and all major adverse cardiac events （MACE） were recorded.Results：In this study,there were 285 patients with fQRS ECG in the 513 patients with NSTEMI.The number of patients with 0-2 coronary arteries narrowed by ≥50% in fQRS group were less while patients with 3 narrowed arteries were more than in the non-fQRS group （P =0.042）.There were fewer Killip Class Ⅰ patients in the fQRS group （P =0.019）,while Killip Class Ⅱ,Ⅲ,and Ⅳ patients were more in the fQRS group than in the non-fQRS group （P =0.019）.Left ventricular ejection fraction levels were significantly lower in the fQRS group （P =0.021）.Baseline total cholesterol,low-density lipoprotein,creatinine,creatine kinase,homocysteine,high-sensitivity C-reactive protein （CRP）,and red blood cells distribution width levels were significantly higher in the fQRS group.Total MACE （MACE,P =0.028）,revascularization （P =0.005）,and recurrent angina （P =0.005） were also significantly greater in the fQRS group.On final logistic regression analysis,after adjusting for baseline variables,the following variables were independent predictors of fQRS：Coronary artery narrowing （P =0.035）,Killip classification （P =0.026）,and total cholesterol （P =0.002）.The following variables were found to be independent predictors of preoperative MACE：Hemoglobin （P =0.000）,gender （P =0.026）,fQRS （P =0.016）,and time from myocardial infarction to balloon or coronary artery bypasses grafting （P =0.013）.Conclusions：The fQRS complexes are commonly present in NSTEMI and the fQRS complexes are an independent predictor of MACE in NSTEMI patients.The number of narrowed coronary arteries,Killip classification,and total cholesterol are all independent predictors of the fQRS complexes.

Biomarkers enhance the long-term predictive ability of the KAMIR risk score in Chinese patients with ST-elevation myocardial infarction

Background:The Global Registry of Acute Coronary Events (GRACE) score is recommended by current ST-elevation myocardial infarction (STEMI) guidelines.But it has inherent defects.The present study aimed to investigate the more compatible risk stratification for Chinese patients with STEMI and to determine whether the addition of biomarkers to the Korea Acute Myocardial Infarction Registry (KAMIR) score could enhance its predictive value for long-term outcomes.Methods:A total of 1093 consecutive STEMI patients were included and followed up 48.2 months.Homocysteine,hypersensitive C-reactive protein (hs-CRP),and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were detected.The KAMIR score and the GRACE score were calculated.The performance between the KAMIR and the GRACE was compared.The predictive power of the KAMIR alone and combined with biomarkers were assessed by the receiver-operating characteristic (ROC) curve.Results:The KAMIR demonstrated a better risk stratification and predictive ability than the GRACE (death:AUC = 0.802 vs.0.721,P<0.001;major adverse cardiovascular events (MACE):AUC = 0.683 vs.0.656,P<0.001).It showed that the biomarkers could independently predict death [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.052 (1.000–1.104),P= 0.018;NT-pro BNP:HR= 1.142 (1.004–1.280),P= 0.021] and MACE [homocysteine:HR= 1.019 (1.015–1.024),P<0.001;hs-CRP:HR= 1.012 (1.003–1.021),P= 0.020;NT-pro BNP:HR= 1.136 (1.104–1.168),P= 0.006].When they were used in combination with the KAMIR,the area under the ROC curve (AUC) significantly increased for death [homocysteine:AUC = 0.802 vs.0.890,Z = 5.982,P<0.001;hs-CRP:AUC = 0.802 vs.0.873,Z= 3.721,P<0.001;NT-pro BNP:AUC= 0.802 vs.0.871,Z = 2.187,P= 0.047;homocysteine,hs-CRP and NT-pro BNP:AUC = 0.802 vs.0.940,Z = 6.177,P<0.001] and MACE [homocysteine:AUC = 0.683 vs.0.771,Z= 6.818,P<0.001;hs-CRP:AUC= 0.683 vs.0.712,Z= 2.022,P= 0.031;NT-pro BNP:AUC= 0.683 vs.0.720,Z= 2.974,P= 0.003;homocysteine,hs-CRP and NT-pro BNP:AUC= 0.683 vs.0.789,Z= 6.900,P<0.001].Conclusion:The KAMIR is better than the GRACE in risk stratification and prognosis prediction in Chinese STEMI patients.A combination of above-mentioned biomarkers can develop a more predominant prediction for long-term outcomes.

Percutaneous treatment in acute coronary syndromes

Both ST-segment elevation myocardial infarction and non-ST-segment elevation acute coronary syndromes (ACS) are the result of an acute thrombotic lesion obstructing blood flow in the coronary vasculature. Percutaneous treatment has shown to improve clinical outcome in this clinical setting by resolving coronary obstruction with different devices directed to restore coronary blood flow. In comparison with balloon alone angioplasty, implantation of bare metal stents reduced the rate of restenosis and cardiac events, but high rates of restenosis remained, leading to further investigations to develop drug-eluting stents with different pharma- cological coatings that reduced restenosis rates and clinical events. In this review, we discuss the current treatment of ACS, reviewing recent randomized clinical trials and advances in medical treatment, including new antiplatelet agents and recent guideline recommendations.

Non-HDL-C水平和ApoB/ApoA1比值与初发心肌梗死的相关性研究

目的探究不同非高密度脂蛋白胆固醇(non-HDL-C)水平初次急性心肌梗死患者的临床特征及载脂蛋白B(Apo B)和载脂蛋白A1(Apo A1)比值以及non-HDL-C与冠状动脉(冠脉)病变程度的相关性。方法选取2021年12月至2023年4月于重庆医科大学附属第一医院心内科入院治疗的首次诊断为急性心肌梗死且行冠脉造影的患者410例。计算Apo B/Apo A1比值及non-HDL-C,根据non-HDL-C三分位数分为低non-HDL-C组(≤2.89 mmol/L)、中non-HDL-C组(2.9~4.16 mmol/L)、高non-HDL-C组(≥4.17 mmol/L),比较三组患者一般临床资料及冠脉病变特点的差异性。另采用Spearman秩相关和二元Logistics回归分析non-HDL-C水平、Apo B/Apo A1对冠脉病变严重程度的影响。结果与低non-HDL-C组相比,中non-HDL-C组和高non-HDL-C组患者年龄更小(P<0.05);高non-HDL-C组较另外两组具有更高水平的体质指数(BMI)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、ApoB、ApoA1、ApoB/ApoA1、白蛋白、γ-谷酰转移酶、尿酸(P<0.05)。三组间左前降支病变、回旋支病变、多支血管病变、Gensini评分相比,差异有统计学意义(P<0.05)。偏相关分析显示Apo B/Apo A1和non-HDL-C均与多支血管病变、Gensini评分呈正相关(P<0.05);多因素二元Logistics回归分析显示ApoB/ApoA1比值(OR=3.149,95%CI:1.209~8.201,P=0.019)、non-HDL-C≥4.17 mmol/L(OR=4.199,95%CI:1.524~11.565,P=0.006)是多支血管病变的独立危险因素。结论在初次急性心肌梗死青年患者有冠脉病变或(冠状动脉粥样硬化性心脏病)危险因素中,更应关注ApoB/ApoA1及non-HDL-C,同时严格控制non-HDL-C是心肌梗死患者潜在的降脂目标。

Effect of Danlou Tablet(丹蒌片) on Peri-procedural Myocardial Injury among Patients undergoing Percutaneous Coronary Intervention for Non-ST Elevation Acute Coronary Syndrome:A Study Protocol of A Multicenter,Randomized,Controlled Trial

Background： It has been shown that administration of statins reduced the risk of peri-procedural myocardial damage. However, it remains unclear whether Chinese medicine Danlou Tablet （~）~）, similar to statins, may protect patients undergoing percutaneous coronary intervention （PCI） from peri-procedural myocardial damage. Objective： To demonstrate the hypothesis whether treatment with Danlou Tablet would improve clinical outcome in patients undergoing selective PCI with non-ST elevation acute coronary syndrome （NSTE-ACS） in China. Methods： Approximately 220 patients with unstable angina or non-ST-segment elevation myocardial infarction undergoing PCI will be enrolled and randomized to Danlou Tablet treatment （4.5 g/day for 2 days before intervention, with a further 4.5 g/day for 90 days thereafter） or placebo. All patients will not receive Danlou Tablet before procedure. The primary end point is to evaluate the incidence of cardiac death, myocardial infarction or unplanned re-hospitalization and revascularization after 30 days in patients undergoing selective PCI treated with Danlou Tablet compared with placebo. Secondary endpoints include the incidence of peri-procedural myocardial injury, 3-month clinical outcomes, the quality of life and Chinese medicine syndromes assessment. Conclusion： This study protocol will provide important evidence of Danlou Tablet treatment on the peri-procedural myocardial injury in patients with NSTE-ACS undergoing selective PCI, which may support a strategy of routine Danlou Tablet therapy to improve the clinical outcomes.

Non-HDL-C和RLP-C与急性ST段抬高型心肌梗死行急诊PCI住院期间不良心脏事件的相关性研究

目的 探讨非高密度脂蛋白胆固醇(non-HDL-C)和残粒脂蛋白胆固醇(RLP-C)与急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)住院期间发生不良心脏事件的相关性。方法 回顾性选取2017年1月~2018年6月在安徽省立医院就诊并接受急诊PCI手术的STEMI患者400例(入院前1个月内均无他汀类药物的持续服用史),根据患者住院期间是否发生主要不良心脏事件(MACE),将其分为MACE组(32例)和良好组(368例)。对所有患者进行血脂检测,并计算其non-HDL-C和RLP-C值。比较MACE组与良好组之间的non-HDL-C和RLP-C值差异,并通过多因素logistic回归分析non-HDL-C和RLP-C与STEMI患者行急诊PCI手术住院期间发生MACE的相关性。结果 与良好组相比,MACE组患者的non-HDL-C和RLP-C值均显著升高,差异有统计学意义(P<0.01)。多因素logistic回归分析表明,non-HDL-C和RLP-C值是STEMI患者发生院内MACE的独立预测因素(OR=1.728,1.672;P<0.01)。结论 non-HDL-C和RLP-C水平与STEMI行急诊PCI手术住院期间MACE的发生情况密切相关,积极控制non-HDL-C和RLP-C可能有助于防止急性心肌梗死的发生,检测non-HDL-C和RLP-C值可能有助于STEMI早期风险的评估。

高度房间传导阻滞对急性非ST段抬高型心肌梗死病人院内新发心房颤动的影响

目的:探讨非ST段抬高型心肌梗死(NSTEMI)病人中高度房间传导阻滞(aIAB)和院内新发心房颤动(NOAF)之间的关系。方法:连续纳入2020年9月—2022年11月就诊于睢宁县人民医院并诊断为NSTEMI,在24 h内行冠状动脉血运重建治疗的病人。所有病人在首次医疗接触时记录标准的12导联心电图。图像被放大并使用半自动卡尺进行分析并获取aIAB。入院后,采用持续心电监测记录可疑心房颤动心律,并立刻通过12导联心电图确认。结果:共纳入820例NSTEMI病人,其中81例(9.9%)NOAF病人,根据有无AF将病人分为w/o NOAF组和NOAF组。与w/o NOAF组比较,NOAF组年龄、心率、Killip分级、C反应蛋白(CRP)、超敏肌钙蛋白T(hs-TnT)、N-末端B型钠尿肽前体(NT-proBNP)、住院时间、aIAB和右冠状动脉(RCA)比例均升高,左前降支(LAD)比例和左室射血分数(LVEF)降低,差异均有统计学意义(P<0.05)。将以上危险因素进行调整后发现,年龄、心率、LAD、LVEF和aIAB是院内发生NOAF的独立危险因素。受试者工作特征(ROC)曲线结果显示,年龄和aIAB对NSTEMI病人院内NOAF有较好的预测价值。将aIAB加入到NOAF的传统模型后,重分类改善指标(NRI)和综合判别改善指数(IDI)得到显著改善(P<0.001)。结论:NSTEMI病人aIAB与较高的院内NOAF风险相关,且aIAB对NOAF具有较好的特异度和敏感度。

miR-16-5p联合miR-206评估非ST段抬高型急性心肌梗死病变严重程度及预后的价值

目的探究微小RNA-16-5p(miR-16-5p)联合miR-206评估非ST段抬高型急性心肌梗死(NSTEAMI)病变严重程度及预后的价值。方法回顾性选取本院在2019年7月—2021年7月间收治的121例行经皮冠状动脉介入术(PCI)治疗的NSTEAMI患者纳入研究。检测患者入院时miR-16-5p、miR-206水平,并分析其与患者病变严重程度的关系。术后对患者进行为期12个月的随访,观察患者不良心血管事件(MACE)发生情况,并将其分为预后良好组和预后不良组。比较两组患者临床相关资料和miR-16-5p、miR-206表达水平。多因素分析NSTEAMI患者PCI术后发生MACE的影响因素,受试者工作特征(ROC)曲线分析miR-16-5p、miR-206对患者PCI术后预后的预测价值。结果NSTEAMI患者PCI术后12个月内预后不良发生率为28.93%(35/121)。重度病变患者miR-16-5p、miR-206水平均高于轻度病变,且miR-16-5p、miR-206水平与患者冠状动脉病变严重程度呈正相关(P<0.05)。预后不良组年龄≥60岁占比、Killip分级≥3级占比、重度病变占比、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)、miR-16-5p、miR-206水平均高于预后良好组(P<0.05)。二元Logistic回归分析结果显示,Killip分级(OR=2.413,95%CI:1.486-3.915)、BNP水平(OR=1.628,95%CI:1.159-2.285)、miR-16-5p水平(OR=2.487,95%CI:1.249-4.948)、miR-206水平(OR=1.423,95%CI:1.100-1.839)是影响患者预后的独立危险因素(P<0.05)。ROC曲线结果显示,miR-16-5p、miR-206预测患者预后的敏感度分别为71.40%、74.30%、88.60%,特异性分别为74.40%、72.10%、91.90%,曲线下面积(AUC)分别为0.819、0.795、0.935(P<0.05)。结论miR-16-5p、miR-206与NSTEAMI患者病变程度呈正相关,且是影响患者预后的独立危险因素,且二者联合检测对患者预后有较好预测价值。

非瓣膜性房颤合并急性心肌梗死患者血清MIP-1α,SCUBE1表达水平及其临床诊断价值

目的 探究非瓣膜性房颤(NVAF)合并急性心肌梗死(AMI)患者血清巨噬细胞炎症蛋白-1α(MIP-1α),信号肽-CUB-表皮生长因子结构域包含蛋白1(SCUBE1)表达水平及其临床诊断价值。方法 选取2021年4月-2023年5月在北大荒集团建三江医院收治的155例NVAF患者作为观察对象(观察组),根据是否合并AMI将患者分为未合并AMI组128例与合并AMI组27例,同时选取在本院健康检查的155名人员为对照组,比较各组血清MIP-1α、SCUBE1水平。受试者工作特征(ROC)曲线分析血清MIP-1α,SCUBE1对NVAF合并AMI的诊断价值。Logistic分析影响NVAF合并AMI的因素。结果 观察组血清MIP-1α、SCUBE1水平高于对照组(P<0.05)。合并AMI组左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期容积(LVEDV)显著低于未合并AMI组,血清MIP-1α和,SCUBE1水平、心房颤动(以下简称房颤)卒中风险评分(CHA2DS2-VASc)高于未合并AMI组(P<0.05)。ROC曲线分析显示,血清MIP-1α、SCUBE1水平辅助诊断NVAF患者合并AMI的曲线下面积(AUC)分别是0.819(95%CI:0.728~0.910)、0.784(95%CI:0.680~0.889),二者联合预测的AUC为0.917(95%CI:0.870~0.964),优于二者单独检测(Z=1.857、2.251, P<0.05)。Logistic分析显示,MIP-1α、SCUBE1是NVAF患者合并AMI的影响因素(P<0.05)。结论 NVAF合并AMI患者血清MIP-1α、SCUBE1水平升高,二者联合检测提高了对合并AMI的诊断效能,可能是NVAF合并AMI的潜在评估指标。

LVEF对STEMI合并non-IRA CTO患者PCI术预后的影响

目的 探讨非梗死相关动脉(non-IRA)慢性完全闭塞(CTO)合并ST段抬高心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术的预后与左心室射血分数(LVEF)之间的关系。方法 选取STEMI患者130例,根据LVEF水平分为LVEF降低组和LVEF保留组;根据是否合并CTO分为CTO亚组和无CTO亚组。随访1年,比较两组患者的全因死亡和主要心血管不良事件(MACE)。结果 与无CTO亚组比较,LVEF降低患者CTO亚组有更高全因死亡率和MACE发生率;而LVEF保留患者CTO亚组与无CTO亚组之间上述指标差异无显著性。在LVEF降低患者中,non-IRA CTO是全因死亡和MACE的独立预测因子。结论 non-IRA CTO是LVEF降低STEMI患者全因死亡和MACE的独立预测因子。

地中海饮食模式和急性非ST段抬高型心肌梗死发生风险的关系研究

目的探讨地中海饮食模式与急性非ST段抬高型心肌梗死(NSTEMI)发生风险的相关性。方法本研究是一项单中心大型病例对照研究。收集2017年1月至2020年12月在首都医科大学附属北京安贞医院首次确诊为急性NSTEMI的患者600例作为急性NSTEMI组。根据年龄、性别进行1∶1匹配选取同期本院体检中心健康体检者600人作为对照组。比较2组一般资料。根据饮食频率调查问卷计算出改良地中海饮食评分(AMEDS)。将所有受试者按AMEDS分为AMEDS<4分组、AMEDS 4~5分组和AMEDS≥6分组。分析总体及不同AMEDS组的急性NSTEMI发生风险,分析AMEDS中不同种类食物与急性NSTEMI发生风险的相关性。结果急性NSTEMI组有高血压病、糖尿病病史的患者比例、收缩压、体重指数、目前吸烟者比例均高于对照组,家庭收入≥120000元/年的比例、AMEDS均低于对照组,差异均有统计学意义(均P<0.05)。相对于AMEDS<4分组的受试者而言,AMEDS 4~5分组以及AMEDS≥6分组受试者急性NSTEMI发生风险明显降低(调整年龄、性别、受教育年限、家庭年收入、病史、体重指数、血压、血红蛋白、生活方式等多个协变量后的多因素分析比值比=0.72,95%置信区间:0.53~0.94,P=0.031;比值比=0.62,95%置信区间:0.47~0.84,P=0.008)。将患者按年龄和性别进行分层,多因素回归分析后发现,随AMEDS增加,急性NSTEMI发生风险降低的趋势在男性和年龄<60岁的人群依然存在(均P<0.05),在女性和≥60岁的人群中,趋势差异无统计学意义(均P>0.05),同时分层之间交互性分析后差异均无统计学意义(均P>0.05)。AMEDS食物种类分析结果显示,蔬菜、鱼类降低急性NSTEMI发生风险,红肉或加工肉类增加其发生风险(比值比=0.51,95%置信区间:0.42~0.66,P<0.001;比值比=0.75,95%置信区间:0.59~0.94,P=0.010;比值比=1.51,95%置信区间:1.21~1.90,P<0.001)。结论地中海饮食模式和急性NSTEMI的发生相关,改良地中海饮食的高依从性可能降低急性NSTEMI的发生风险。

血管内超声参数联合microRNA-206评估非ST段抬高型急性心肌梗死患者病变严重程度及预后的价值

目的探讨血管内超声(IVUS)参数联合microRNA-206(miR-206)评估非ST段抬高型急性心肌梗死(NSTEAMI)患者病变严重程度及预后的价值。方法选取2019年3月-2021年4月河北北方学院附属第一医院收治的105例NSTEAMI患者,所有患者行经皮冠状动脉介入术(PCI),根据病变严重程度将患者分为单支病变组(55例)、双支病变组(32例)、多支病变组(18例)。对比不同病变程度患者IVUS参数、血清miR-206,分析IVUS参数、血清miR-206与NSTEAMI患者病变严重程度的相关性。随访2年,根据是否发生MACE分为发生组与非发生组。对比发生组与非发生组的临床资料,采用多因素逐步Logistic回归模型分析NSTEAMI患者发生主要不良心脏事件(MACE)的影响因素。绘制受试者工作特征(ROC)曲线,评估IVUS参数、血清miR-206预测NSTEAMI患者发生MACE的效能。结果多支病变组斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于单支、双支组(P<0.05),且双支病变组均高于单支病变组(P<0.05)。Pearson相关性分析结果显示,血管外弹力膜面积与NSTEAMI患者病变严重程度无相关性(r=0.271,P=0.325);斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206与NSTEAMI患者病变严重程度呈正相关(r=0.416、0.382、0.423、0.507和0.394,均P=0.000)。随访2年,失访2例,剩余103例患者中32例(31.07%)发生MACE,71例(68.93%)未发生MACE。发生组多支病变、血运未重建占比、斑块负荷、斑块面积、重构指数、偏心指数、血清miR-206相对表达量均高于非发生组(P<0.05),淋巴细胞计数、血红蛋白水平均低于非发生组(P<0.05)。多因素逐步Logistic回归分析结果显示:多支病变[OR=3.466(95%CI:1.523,7.884)]、血运未重建[OR=2.776(95%CI:1.220,6.315)]、斑块负荷[OR=3.155(95%CI:1.387,7.177)]、重构指数[OR=3.842(95%CI:1.689,8.740)]、偏心指数[OR=4.166(95%CI:1.831,9.477)]、血清miR-206[OR=4.500(95%CI:1.978,10.236)]为NSTEAMI患者发生MACE的危险因素(P<0.05)。ROC曲线结果显示,斑块负荷、重构指数、偏心指数、血清miR-206四者联合预测NSTEAMI患者发生MACE的敏感性为88.52%(95%CI:0.674,0.957),特异性为92.86%(95%CI:0.713,0.968),曲线下面积为0.900(95%CI:0.812,0.953)。结论IVUS参数(斑块负荷、重构指数、偏心指数)、血清miR-206在评估NSTEAMI患者病变严重程度与预后中具有重要价值,且四者联合具有更高的预测价值。

NLR与MSI对急性NSTEMI短期预后判断价值

目的本研究旨在探讨校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR)在判断急性非ST段抬高型心肌梗死(NSTEMI)患者短期内可能出现不良预后的预测能力。方法研究组选择2020年3月到2021年9月期间,首次就诊急诊科明确诊断为急性非ST段抬高型心肌梗死的276例患者。通过快速急诊绿道监测血压与心率,并于急诊科10 min内抽取血常规、床旁心脏彩超等相关化验检查,依据监测及化验结果,研究小组计算了校正休克指数(MSI)和中性粒细胞/淋巴细胞比值(NLR),然后根据统计结果将患者分为2组:NLR≥5.0组(n=75)与NLR﹤5.0组(n=201);(2)MSI≥1.2组(n=57)与MSI<1.2组(n=219)。比较2组一般资料情况,发生不良心血管事件的比例,采用受试者ROC曲线下面积来评估NLR值和MSI值对NSTEMI院内不良心血管事件的预测能力。结果连续入选的276例NSTEMI患者中,发生不良心血管事件52例,占18.8%,心源性休克患者15例,占5.4%,恶性心律失常患者24例,占8.7%,死亡13例,占4.7%。NLR≥5.0与MSI≥1.2值组的心功能、收缩压(SBP)、舒张压(DBP)及心率(HR)分别与NLR<5.0与MSI<1.2组比较,差异有统计学意义(P<0.05);NLR≥5.0与MSI≥1.2组MACE发生率分别高于NLR<5.0组与MSI<1.2组(P<0.05)。此外,NLR和MSI的ROC曲线下面积分别为0.734和0.703,提示NLR和MSI均具有评价急性非ST段抬高型心肌梗死患者短期不良心血管事件发生能力。结论MSI与NLR是评估NSTEMI短期不良预后的两个简单的重要的易获得指标。