Effects of high-dose glucose-insulin-potassium on acute coronary syndrome patients receiving reperfusion therapy:a meta-analysis

BACKGROUND:This meta-analysis aimed to assess the efficacy of high-dose glucose-insulinpotassium(GIK) therapy on clinical outcomes in acute coronary syndrome(ACS) patients receiving reperfusion therapy.METHODS:We searched the PubMed,Web of Science,MEDLINE,Embase,and Cochrane Library databases from inception to April 26,2022,for randomized controlled trials(RCTs) that compared high-dose GIK and placebos in ACS patients receiving reperfusion therapy.The primary endpoint was major adverse cardiovascular events(MACEs).RESULTS:Eleven RCTs with 884 patients were ultimately included.Compared with placebos,high-dose GIK markedly reduced MACEs(risk ratio [RR] 0.57,95% confidence interval [95% CI]:0.35 to 0.94,P=0.03) and the risk of heart failure(RR 0.48,95% CI:0.25 to 0.95,P=0.04) and improved the left ventricular ejection fraction(LVEF)(mean difference [MD] 2.12,95% CI:0.40 to 3.92,P=0.02) at 6 months.However,no difference was observed in all-cause mortality at 30 d or 1 year.Additionally,high-dose GIK was significantly associated with increased incidences of phlebitis(RR 4.78,95% CI:1.36 to 16.76,P=0.01),hyperglycemia(RR 9.06,95% CI:1.74 to 47.29,P=0.009) and hypoglycemia(RR 6.50,95% CI:1.28 to 33.01,P=0.02) but not reinfarction,hyperkalemia or secondary reperfusion.In terms of oxidative stress-lowering function,high-dose GIK markedly reduced superoxide dismutase(SOD) activity but not glutathione peroxidase(GSH-Px) or catalase(CAT) activity.CONCLUSION:Patients with ACS receiving reperfusion therapy exhibited a reduction in MACEs and good oxidative stress-lowering eflcacy in response to high-dose GIK.Moreover,with a higher incidence of complications such as phlebitis,hyperglycemia,and hypoglycemia.Furthermore,there were no observed survival benefits associated with high-dose GIK.More trials with long-term follow-up are still needed.

Correlation of peripheral blood CCR7 expression with myocardial injury and inflammatory reaction in patients with acute coronary syndrome

Objective:To study the correlation of peripheral blood chemokine receptor 7 (CCR7) expressions with myocardial injury and inflammatory reaction in patients with acute coronary syndrome.Methods: Patients who were diagnosed with stable angina pectoris, unstable angina pectoris, non-ST-elevation myocardial infarction and ST-elevation myocardial infarction in Chengdu Fifth People's Hospital between May 2014 and October 2016 were selected as SAP group, UAP group, USTEMI group and STEMI group respectively;healthy volunteers who received physical examination during the same period were selected as control group. The expression of CCR7 in peripheral blood mononuclear cells and the contents of myocardial injury and inflammatory response markers in serum were determined.Results: CCR7 mRNA expression in peripheral blood mononuclear cells as well as serum IL-1, IL-6, IL-18, MMP2 and MMP9 contents of UAP group, USTEMI group and STEMI group were significantly higher than those of SAP group and control group;serum CK-MB, Myo and cTnI contents of USTEMI group and STEMI group were significantly higher than those of SAP group and control group, and serum CK-MB, Myo and cTnI contents of UAP group were not different from those of SAP group and control group;CCR7 mRNA expression in peripheral blood mononuclear cells was positively correlated with serum CK-MB, Myo, cTnI, IL-1, IL-6, IL-18, MMP2 and MMP9 contents.Conclusion: Highly expressed CCR7 in peripheral blood of patients with acute coronary syndrome can aggravate myocardial injury by activating inflammatory reaction.

Antiphospholipid syndrome presenting as recurrent coronary thrombosis:A case report

BACKGROUND Antiphospholipid syndrome(APS)is a chronic autoimmune disease characterized by venous or arterial thrombosis,pregnancy morbidity and a variety of other autoimmune and inflammatory complications.Here,we report a case of APS associated with multiple coronary thromboses.CASE SUMMARY The patient,a 28-year-old male,suffered from recurrent coronary thromboses over a period of 31 months.Despite undergoing interventional coronary procedures,thrombolytic therapy,and anticoagulation treatment,the condition persisted intermittently.An extensive search for underlying thrombogenic factors revealed a diagnosis of APS.Accurate adjustment of the medication regimen led to the absence of further acute coronary syndrome(ACS)episodes during the subsequent 20-month follow-up.Although the patient occasionally experiences chest tightness,no further symptoms of distress have been reported.CONCLUSION APS can manifest as ACS.Screening for rheumatologic and immunological conditions is essential when encountering patients with multiple coronary thromboses.Treatment strategy should include symptomatic relief and a targeted and aggressive approach to address the underlying pathophysiology.

Update on pharmacological treatment of acute coronary syndrome without persistent ST segment elevation myocardial infarction in the elderly

The increase in cardiovascular disease prevalence with ageing has been attributed to several age-related changes such as changes in the vascular wall elasticity, the coagulation and haernostatic system and endothelial dysfunction, among other causes. There is a 50% increased mortality risk per 10-year increase in age starting at 65 years old. Here, we aimed to discuss pharmacological treatment in acute coronary syndrome （ACS） without persistent ST segment elevation myocardial infarction in the elderly. The main aim of ACS treatment in elderly people is at preventing ischemia, myocardial damage and complications. A meta-analysis suggests that invasive revascularization therapy is probably most useful in older patients. Dual antiplatelet therapy is currently the standard of care post-ACS. Platelet P2Y12 inhibitors are among the most commonly used medications worldwide, due to their established benefits in the treatment and prevention of arterial throm- bosis. The main recommendation is to tailor antithrombotic treatment, considering body weight, renal function （Class I, level C） and careful evaluation of life expectancy, comorbidities, risk/benefit profile, quality of life and fxailty when invasive strategies are considered （Class IIa, level A） on top of the different recommendations given for a general non ST elevation ACS population. It is obvious that potent P2Y12 in- hibitors will continue to play an important role in pharmacological treatment for elderly ACS patients in the future.

Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.

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.

Correlation of serum free fatty acid content with lipid metabolism disorder and inflammatory response activation in patients with acute coronary syndrome

Objective:To study the correlations of serum free fatty acid content with lipid metabolism disorder and inflammatory response activation in patients with acute coronary syndrome. Methods: Patients who were diagnosed with acute coronary syndrome in Zigong First People's Hospital between March 2015 and April 2017 were chosen as the ACS group of the research, patients who were diagnosed with stable angina pectoris during the same period were chosen as the SAP group and the volunteers who accepted physical examination during the same period were chosen as the control group. Serum was collected to determine the levels of free fatty acid, lipid metabolism indexes, inflammatory response indexes and adipocytokines. Results: Serum free fatty acid, LDL-C, PCSK9, ApoB, IL-6, IL-17, Chemerin and Visfatin levels of ACS group and SAP group were higher than those of control group whereas HDL-C, ApoA1, ApoA5, IL-10, sFGL2, TGFβ1, SFRP5, Omentin-1 and Vaspin levels were lower than those of control group;serum free fatty acid, LDL-C, PCSK9, ApoB, IL-6, IL-17, Chemerin and Visfatin levels of ACS group were higher than those of SAP group whereas HDL-C, ApoA1, ApoA5, IL-10, sFGL2, TGFβ1, SFRP5, Omentin-1 and Vaspin levels were lower than those of SAP group.Conclusion: The increase of free fatty acid in serum of patients with acute coronary syndrome is closely related to the lipid metabolism disorder and inflammatory response activation.

Influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance

Objective: To explore the influence of ticagrelor on platelet function, plaque properties and inflammatory response in patients with acute coronary syndrome (ACS) complicated by clopidogrel resistance. Methods: A total of 58 patients with acute coronary syndrome complicated by clopidogrel resistance who were treated in Xiangyang No.1 People's Hospital between August 2015 and April 2017 were divided into control group (n=29) and ticagrelor group (n=29) by random number table method. Control group were treated with aspirin combined with doubling dosage of clopidogrel, and ticagrelor group were treated with aspirin combined with ticagrelor. The differences in platelet function, plaque properties, inflammatory response, and so on were compared between the two groups before and after treatment. Results: There were no significant differences in platelet function, plaque properties and inflammatory response between the two groups before treatment. After 7 d and 14 d of treatment, platelet function indexes MPAR and PRI levels in ticagrelor group were lower than those in control group;serum plaque property-related indexes Hcy, sCD40 and sCD40L contents were lower than those in control group;serum inflammatory factors CRP and MPO contents were lower than those in control group whereas APN contents were higher than those in control group. Conclusion: Ticagrelor therapy can effectively inhibit the platelet activity, stabilize the plaques and reduce the systemic inflammatory response in patients with acute coronary syndrome complicated by clopidogrel resistance.

Meta-analysis of the diagnosis and treatment of traditional medicine for acute coronary syndrome

The morbidity and mortality of acute coronary syndrome disease is extremely high and is the main cause of human death.As an important part of the wisdom of the Chinese nation,TCM plays an important role in treatment.By reviewing recent related research and reports on TCM theories,Chinese herbal formulas,Chinese and Western medicine treatment and other considerations,it aims to provide ideas and references for clinical treatment.

Bleeding risk assessment in elderly patients with acute coronary syndrome

Nowadays,elderly people represent a growing population segment with a well known increased risk of both ischemic and bleeding events.Current acute coronary syndrome guidelines,strongly recommend dual antiplatelet therapy(DAPT)with few specific references for aged patients due to lack of evidence.Patients aged>75 years are misrepresented in the classic derivation trials cohorts.Strategies to reduce the bleeding risk in this group of patients are urgently needed for the daily clinical practice.Identify the specific age related bleeding risk factors and the importance of an integral geriatric assessment remains challenging.Some of the available in-hospital and out-hospital bleeding risk scores have shown a lower to moderate predictive ability in older patients and no specific tools are developed in elderly population.The importance of an appropriate vascular access choice,type and duration of antiplatelet drugs is crucial to reduce the bleeding risk.Increase radial approaches and short DAPT duration leads to reduce hemorrhages.One interesting subgroup of patients is those who need chronic anticoagulation therapy after percutaneous coronary intervention,due to their very high risk of bleeding.New alternatives as dual therapy with oral anticoagulation and only one antiplatlet drug should be considered.In current review,we evaluate the available evidence about bleeding risk in elderly.

Interrelation between arterial inflammation in acute coronary syndrome and circadian variation

At present,the study into inflammatory markers has become a new tool which is most useful for establishing the prognosis of patients with acute coronary syndrome.The inflammatory substrate involved is acute coronary syndrome is extremely complex,with a large number of factors involved both in its activation and its modulation.It is known that C-reactive protein play a key role in the physiopathology of the atherosclerosis.Furthermore,scientific literature reports that the existence of a circadian rhythm in the triggering of cardiovascular accidents can suggest the implication of,or association with these physiological rhythms that show activity peaks at particular times of the day or night.Keeping in mind the potential association between inflammation and circadian rhythm,a better understanding of the kinetics of said markers could lead to improvements in their use in cardiovascular diseases.Considering the diversity of the diurnal variations in the intrinsic properties of the cardiovascular system,these should be kept in mind during the design of in vivo experimental studies.As such,the information available reinforces our opinion when suitably validating the biomarkers and the need to demon-strate their reliability,stability,and lack of variability and standardise the methodology of their measurement.

Acute coronary syndromes： an old age problem

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes （ACS）. This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological tiailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.

Bleeding risk stratification in an era of aggressive management of acute coronary syndromes

Major bleeding is currently one of the most common non-cardiac complications observed in the treatment of patients with acute coronary syndrome(ACS). Hemorrhagic complications occur with a frequency of 1% to 10% during treatment for ACS. In fact, bleeding events are the most common extrinsic complication associated with ACS therapy. The identification of clinical characteristics and particularities of the antithrombin therapy associated with an increased risk of hemorrhagic complications would make it possible to adopt prevention strategies, especially among those exposed to greater risk. The international societies of cardiology renewed emphasis on bleeding risk stratification in order to decide strategy and therapy for patients with ACS. With this review, we performed an update about the ACS bleeding risk scores most frequently used in daily clinical practice.

Severity evaluation value of serum myeloperoxidase content detection in patients with acute coronary syndrome

Objective:To analyze the value of serum myeloperoxidase content detection for severity evaluation in patients with acute coronary syndrome.Methods: Acute coronary syndrome (ACS) group included 32 cases, stable angina pectoris (SAP) group included 46 cases, levels of myeloperoxidase (MPO), inflammatory factors and lipid metabolism indexes in serum were compared, coronary echocardiography blood flow parameters were detected, and the correlation between MPO and ACS severity-associated indexes was further analyzed.Results:MPO content in serum of ACS group was significantly higher than those of SAP group and control group;inflammatory factors hs-CRP, IL-6, MCP-1 and LP-PLA2 content in serum were higher than those of SAP group and control group while IL-13 and TGFβ content were lower than those of SAP group and control group;lipid metabolism indexes TC, TG, LDL-C, ApoAI and ApoB content in serum were higher than those of SAP group and control group while HDL-C content was lower than that of SAP group and control group;ultrasonic coronary blood flow parameters SPV, DPV, A, CFVR and CTVⅠ levels were lower than those of SAP group and control group. The serum MPO content in patients with ACS was directly correlated with the content of inflammatory factors and lipid metabolism indexes as well as thelevels of coronary blood flow parameters.Conclusions:Serum MPO content in patients with ACS is directly correlated with the disease severity, and can be used as a reliable index for long-term guide of treatment and prediction of treatment outcome.

Diagnosis and treatment of acute pulmonary inflammation in critically ill patients: The role of inflammatory biomarkers

Pneumonia and acute respiratory distress syndrome are common and important causes of respiratory failure in the intensive care unit with a significant impact on morbidity, mortality and health care utilization despite early antimicrobial therapy and lung protective mechanical ventilation. Both clinical entities are characterized by acute pulmonary inflammation in response to direct or indirect lung injury. Adjunct anti-inflammatory treatment with corticosteroids is increasingly used, although the evidence for benefit is limited. The treatment decisions are based on radiographic, clinical and physiological variables without regards to inflammatory state. Current evidence suggests a role of biomarkers for the assessment of severity, and distinguishing sub-phenotypes (hyperinflammatory versus hypo-inflammatory) with important prognostic and therapeutic implications. Although many inflammatory biomarkers have been studied the most common and of interest are C-reactive protein, procalcitonin, and pro-inflammatory cytokines including interleukin 6. While extensively studied as prognostic tools (prognostic enrichment), limited data are available for the role of biomarkers in determining appropriate initiation, timing and dosing of adjunct anti-inflammatory treatment (predictive enrichment)

Coronary artery disease in women:From the yentl syndrome to contemporary treatment

In recent years attention has been raised to the fact of increased morbidity and mortality between women who suffer from coronary disease. The identification of the so called Yentl Syndrome has emerged the deeper investigation of the true incidence of coronary disease in women and its outcomes. In this review an effort has been undertaken to understand the interaction of coronary disease and female gender after the implementation of newer therapeutic interventional and pharmaceutics' approaches of the modern era.

Acute myocardial infarction due to Kounis syndrome:A case report

BACKGROUND Acute myocardial infarction(AMI)can be induced by several factors.However,AMI induced by Kounis syndrome(an allergic reaction)is extremely rare and is highly susceptible to misdiagnosis.CASE SUMMARY A 70-year-old man presented after suffering an allergic reaction that caused chest pain triggered upon eating ice cream.Troponin I was found to be elevated,and an electrocardiogram showed ST-segment elevation.The diagnosis was AMI.He underwent two coronary angiographies,with one intravascular ultrasound during hospitalization showing no evidence of atherosclerotic coronary artery disease.The final diagnosis was vasospastic myocardial infarction due to Kounis syndrome.The patient was then treated with hydrocortisone and intravenous antihistamines,and his chest pain symptoms resolved.CONCLUSION Allergic reactions(such as Kounis syndrome)can cause serious damage to the heart.Physicians should be alert to the consequences and avoid misdiagnosis.

Effect of Shengmai Injection(生脉注射液) on Cardiac Function and Inflammatory Reaction in Patients with Acute Coronary Syndrome

Objective： To confirm the effect of Shengmai Injection （生脉注射液, SMI） in improving cardiac function in patients with acute coronary syndrome （ACS） and to explore its influence on inflammatory reaction in patients. Methods： Ninety ACS patients were randomized into two groups, the control group treated with conventional therapy and the SMI group treated with SMI. The patients＇ cardiac function was noted and the content of high sensitive C-reactive protein （hs-CRP） in venous blood was measured before treatment and 1 week and 3 weeks after treatment, so as to observe and compare their changes between the two groups. Results： The cardiac output, stroke volume and ejection fraction in the SMI group after 3 weeks of treatment were all higher than those in the control group （P〈0.05）. The serum content of hs-CRP was reduced in both groups （P〈0.05）, but the reduction in the SMI group was more significant than that in the control group （P〈0.05）. Conclusion： SMI could improve the cardiac function and further inhibit the inflammatory reaction in patients with ACS.

尼可地尔对急性冠脉综合征患者PCI介入治疗后炎性相关指标的影响

目的探讨急性冠脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)后采用尼可地尔治疗后对炎性相关指标的影响,评估其对血管内皮功能的影响。方法将2022年8月至2023年1月于大连医科大学附属第二医院心血管内科行PCI治疗的66例ACS患者作为研究样本,按照完全随机设计法分成对照组和试验组,每组33例。对照组行常规疗法,试验组用尼可地尔治疗。比较2组患者血清中的炎性指标、同型半胱氨酸(hcy)和不良反应情况。结果尼可地尔治疗后,对照组术后炎性相关因子水平高于试验组,差异具有统计学意义(P<0.05);尼可地尔治疗后Hcy水平低于对照组,差异具有统计学意义(P<0.05);试验组不良反应率高于对照组,差异无统计学意义(P>0.05)。结论尼可地尔应用在老年ACS患者PCI术后疗效确切,能优化血管相关炎性指标,降低同型半胱氨酸水平改善冠状动脉血管内皮功能,适合进一步推广。

Effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

To evaluate the effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS) .Methods Patients with ACS underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) investigation.Patients with culprit vulnerable borderline lesions were enrolled.No coronary inter-vention was performed on these lesions.All the patients received atrovastatin therapy for 12 months and underwent clin-ical follow-up along with IVUS follow-up.Cross section area (CSA) of the targeted lesion,CSA of the reference arter-ies (extra elastic membrane) ,minimal lumen CSA,and plaque area were measured at baseline and follow-ups.Ad-verse events included recurrent angina,recurrent myocardial infarction,revascularization and death.Results No ad-verse events was reported during follow-up period.Compared with baseline data,the level of ApoB decreased signifi-cantly at the end of the study (0.589 ± 0.136 g /L vs 0.681 ± 0.132 g /L,P = 0.03) .Both the percent diameter steno-sis and the percent area stenosis detected by CAG displayed minimal change ((62.50 ± 10.21) % vs (54.79 ± 12.35) % ,P = 0.48 and (58.61 ± 8.36) % vs (48.18 + 10.56) % ,P = 0.78) .Detected by IVUS,the minimal lu-minal CSA of the targeted lesion increased significantly (6.32 ± 2.42 mm2 vs 5.63 ± 2.51 mm2,P < 0.01) ,the plaque area and CSA stenosis decreased (7.70 ± 2.19 mm2 vs 8.17 ± 2.55 mm2,P < 0.05 and 56.94 ± 8.47% vs 61.4 ± 110.34% ,P < 0.01) .A total of 25 soft plaques (50% ) transformed into fibrous plaque.Conclusions Atro-vastatin therapy stabilizes borderline vulnerable plaque and reverses atherosclerosis progression in patients with ACS.