Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

One Case of Primary Thrombocythemia with Concealed Hypokalemia Complicated by Acute Myocardial Infarction

Medical history summary: Male, 47 years old, was admitted to the hospital due to “dizziness accompanied by chest tightness and pain for more than 8 days”. One week ago, the patient experienced chest tightness, chest pain accompanied by profuse sweating for 3 hours and underwent emergency percutaneous coronary intervention (PCI) at a local hospital. The procedure revealed left main stem occlusion with subsequent left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA). After the procedure, the patient experienced hemodynamic instability, recurrent ventricular fibrillation, and critical condition, thus transferred to our hospital for further treatment. Symptoms and signs: The patient is in a comatose state, unresponsive to stimuli, with bilateral dilated pupils measuring 2.0 mm, exhibiting reduced sensitivity to light reflex, and recurrent fever. Coarse breath sounds can be heard in both lungs, with audible moist rales. Irregular breathing pattern is observed, and heart sounds vary in intensity. No pathological murmurs are auscultated in any valve auscultation area. Diagnostic methods: Coronary angiography results at the local hospital showed complete occlusion of the left main stem, and left main stem to left anterior descending artery percutaneous transluminal coronary angioplasty (PTCA) was performed. However, the distal guidewire did not pass through. After admission, blood tests showed a Troponin T level of 1.44 ng/ml and a Myoglobin level of 312 ng/ml. The platelet count was 1390 × 109/L. Von Willebrand factor (vWF) activity was measured at 201.9%. Bone marrow aspiration biopsy showed active bone marrow proliferation and platelet clustering. The peripheral blood smear also showed platelet clustering. JAK-2 gene testing was positive, confirming the diagnosis of primary thrombocytosis. Treatment methods: The patient is assisted with mechanical ventilation and intra-aortic balloon counterpulsation to improve coronary blood flow. Electrolyte levels are closely monitored, especially maintaining plasma potassium levels between 4.0 and 4.5 mmol/l. Hydroxyurea 500 mg is administered for platelet reduction. Anticoagulants and antiplatelet agents are used rationally to prevent further infarction or bleeding. Antiarrhythmic, lipid-lowering, gastroprotective, hepatoprotective, and heart failure treatment are also provided. Clinical outcome: The family members chose to withdraw treatment and signed for discharge due to a combination of reasons, including economic constraints and uncertainty about the prognosis due to the long disease course. Acute myocardial infarction has gradually become one of the leading causes of death in our country. As a “green channel” disease, corresponding diagnostic and treatment protocols have been established in China, and significant progress has been made in emergency care. There are strict regulations for the time taken from the catheterization lab to the cardiac intensive care unit, and standardized treatments are provided to patients once they enter the intensive care unit. Research results show that the incidence of acute myocardial infarction in patients with primary thrombocythemia within 10 years is 9.4%. This type of disease is rare and difficult to cure, posing significant challenges to medical and nursing professionals. In order to benefit future patients, we have documented individual cases of treatment and nursing care for these patients. The research results show that these patients exhibit resistance to traditional oral anticoagulant drugs and require alternative anticoagulants. Additionally, there are significant differences in serum and plasma potassium levels among patients. Therefore, when making clinical diagnoses, it is necessary to carefully distinguish between the two. Particularly, nursing personnel should possess dialectical thinking when supplementing potassium levels in patients in order to reduce the incidence of malignant arrhythmias and mortality rates.

ST-segment elevation: Distinguishing ST elevation myocardial infarction from ST elevation secondary to nonischemic etiologies

The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.

Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.

Culprit vessel only versus ＂one-week＂ staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

ObjectiveTo 探索 &#x0201c 的影响； one-week&#x0201d；上演 multivessel 经皮的冠的干预(一种总线标准)对死亡和主要不利心脏的事件(向)上的犯人唯一的一种总线标准 .MethodsWe&#x000a0 ；回顾地与 multivessel 疾病分析了 447 个病人经历了圣片断举起在在经历在2008年7月26日和9月25日之间的一种总线标准前的 12 h 以内的心肌的梗塞( STEMI )， 2011 。在在梗塞动脉的一种总线标准的结束以后，仍然医院里的 201 个病人同意为 &#x0201c 与超过 70% 狭窄在非梗塞动脉经历一种总线标准； one-week&#x0201d；上演 multivessel 一种总线标准。246 病人 only&#x000a0 的一个总数；为犯人容器的收到的干预。后续在 2014 年 9 月 9 日结束了。这研究从任何原因在死亡检验了差别(即，心脏并且 noncardiac ) 并且在到一条犯人唯一的一种总线标准治疗途径的二治疗 groups.ResultsCompared 之间的向， &#x0201c； one-week&#x0201d；上演 multivessel 一种总线标准强烈与更大的好处被联系为 55 月所有原因死亡[41 (16.7%) vs.13 (6.5%) ， P = 0.004 ] 并且向[82 (33.3%) 对 40 (19.9%) ， P = 0.002 ] 率。另外，在心肌的梗塞的数字有重要差别[43 (17.5%) 对 20 (10.0%) ， P = 0.023 ] ，冠动脉绕过 grafting [CABG；20 (8.1%) 对 6 (3.0%) ， P = 0.021 ] ，并且一种总线标准[31 (12.6%) 对 12 (6.0%) ， P = 0.018 ] 。与 &#x0201c 相比经历犯人唯一的一种总线标准的病人； one-week&#x0201d；一种总线标准有 stent 血栓事件的一样的数字[7 (2.8%) 对 3 (1.5%) ， P = 0.522 ].ConclusionsCompared 到一条犯人唯一的一种总线标准治疗途径， &#x0201c； one-week&#x0201d；上演多容器一种总线标准为 STEMI 和多容器一种总线标准是一只保险箱和有效选择。

Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction： a multicenter random- ized clinical trial

在有单个容器中介狭窄犯人损害优点的心肌的梗塞(STEMI ) 病人进一步学习的尖锐圣片断举起的 stenting 的 BackgroundThe 利益 / 风险比率，因此现在的 study.Methods 和 resultsIt 的题目是一未来， multicenter，使随机化的控制试用。在 2012 年 4 月和 2015 年 7 月之间，有单个容器疾病和中介(40%-70%) 的 399 个尖锐 STEMI 病人在渴望 thrombectomy 或 intracoronary tirofiban 前后的犯人损害的狭窄(15 呍眠獡愠獳' 覒 X 整 ? 楷桴猠杩楮楦慣瑮椠灭潲敶敭瑮椠 ? ?癲癩污椠 ? 慰楴湥獴眠瑩 ??

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

AIM: To evaluate the impact of thrombus aspiration(TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction(STEMI) registry.METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.RESULTS: A total of 456 patients were analyzable and categorized in TA group(156 patients; 34.2%) and non-TA(NTA) group(300 patients; 65.8%). Patientstreated with TA had less prevalence of multivessel disease(39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow < 3(P < 0.001) than NTA group. There was a higher rate of direct stenting(58.7% vs 45.5%, P = 0.009), with shorter(24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents(3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P < 0.001) in the TA group as compared to NTA group. The number of implanted stents(1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION: In an "all-comers" STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention： an updated meta- analysis

BackgroundThe 临床的功效和在有圣片断举起的病人的附属血栓渴望(TA ) 的安全心肌的梗塞(STEMI ) 在经皮的冠的干预(一种总线标准) 期间仍然是 controversial.MethodsTwenty 五合格使随机化的控制试用被包括把血栓渴望(TA ) 的使用与一种总线标准作比较并且为 STEMI 一种总线标准唯一。主要端点是所有原因死亡和死亡。第二等的端点是主要不利心脏的事件(向)，周期性的梗塞( RI )，目标容器 revascularization ( TVR )， stent 血栓(圣)，灌注代理人标记和 stroke.ResultsTIMI 流动分级 3 并且 MBG 2-3 显著地与一种总线标准唯一的手臂相比在 TA 正一种总线标准手臂被增加[相对风险( RR )：1.05， 95% 信心间隔(CI ) ：1.02-1.09， P = 0.004 ] 并且(RR：1.68， 95% CI：1.40-2.00， P &#x0003c；0.001 ) 分别地。在在二个组之间的所有原因死亡，权标， TVR 和圣率没有重要差别。RI 率在有短期的后续持续时间的一种总线标准唯一的手臂比那在 TA 正一种总线标准手臂是更低的(RR：0.60， 95% CI：0.38-0.96， P = 0.03 ) ，但是在在中期或长期的后续时期上的 RI 发生没有重要差别(RR：1.00， 95% CI：0.77-1.29， P = 0.98 ) ，并且(RR：0.96， 95% CI：0.81-1.15， P = 0.69 ) 分别地。在 TA 正一种总线标准在中期或长期的后续时期和粗略的击率上处于粗略的击和击的率有统计上重要的差别(RR：1.60， 95% CI：1.08-2.38， P = 0.02 ) 并且(RR：1.43， 95% CI：1.03-1.98， P = 0.03 ) 分别地；这没在短期的后续时期期间在二只手臂之间被观察(RR：1.47， 95% CI：0.97-2.21， P = 0.07 ).ConclusionsRoutine 在 STEMI 病人的帮助 TA 的一种总线标准能改进心肌的灌注并且得到与临床的端点有关的有限好处，它可以与中风风险被联系。

The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction： results from the Korean Acute Myocardial Infarction National Registry with Registries

用朝鲜数据的以前的研究已经更高报导了的 BackgroundAlthough 在女人死亡评价，在预后的这些性差别是否张贴圣片断举起，是不太清楚的心肌的梗塞(STEMI ) ，很长时间依赖者。这研究的目的是在病人与早、迟了的死亡检验性年龄相互作用， STEMI 在朝鲜全国性的 registry.MethodsThis 注册了未来的从 17,021 个 STEMI 病人根据性和年龄学习成层的结果。我们比较了在里面医院，早(30 天) 并且迟了(12 个月) 在性到之间的死亡在 multivariable models.ResultsIn 检验性年龄相互作用更年轻的女人(< 60 年) ，在里面医院[5.8% 对 2.5% ， P < 0.001；unadjusted 机会比率(或) ：2.41， 95% 信心间隔(CI ) ：1.59-3.66 ] ，早(6.2% 对 2.6% ， P < 0.001；unadjusted 或：2.4， 95% CI：2.12-2.72 ) 并且迟了的死亡(7.0% 对 3.1% ， P > 0.001；unadjusted 或：2.33， 95% CI：2.08-2.61 ) 与男人相比是显著地更高的。然而在为耐心的特征的调整以后， Killip 班 3 ，症状到流血的汽球时间和专业，并且在里面医院流血全面早、迟了的死亡不再与在任何年龄 groups.ConclusionsAmong 的性有关有 STEMI 的一张朝鲜人口，在更年轻的女人的更高早、迟了的死亡可以被差的耐心的特征解释，更高的 Killip 班 3 ，更长的症状到汽球时间和流血的更经常的专业。基于性年龄差别，因此，更精确、好攻击的预防策略集中了于风险因素减小，教育和更集中的管理因为更年轻的女人应该被执行。

Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction (STEMI). This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention (pPCI) for acute STEMI. METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation. Patients were randomly assigned to control group (n=20) or post-dilatation group (n=21) in which a non-compliant balloon was inflated to >16 atm pressure. Strut apposition and coverage were evaluated by optical coherence tomography (OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up. The primary endpoint was rate of incomplete strut apposition (ISA) at 7 months after pPCI. RESULTS: There were similar baseline characteristics except for stent length (21.9 [SD 6.5] mm vs. 26.0 [SD 5.8] mm, respectively, P=0.03). In post-dilatation vs. control group, ISA rate was lower (2.5% vs. 4.5%, P=0.04) immediately after pPCI without affecting nal TIMI ow 3 rate (95.2% vs. 95.0%, P>0.05) or corrected TIMI frame counts (22.6±9.4 vs .22.0±9.7, P>0.05);and at 7-month follow-up (0.7% vs .1.8%, P<0.0001), the primary study endpoint, with similar strut coverage (98.5% vs. 98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events (MACE). CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood ow or 1-year MACE rate. Larger and longer term studies are warranted to further assess safety.

N-terminal pro-B-type natriuretic peptide as prognostic marker for patients of non ST-segment elevation myocardial infarction

In this work, we analyzed only the patients of the NSTEMI (non ST-segment elevation myocardial infarction) who arrived at the hospital within 12 h after symptoms started. Using NSTEMI follow-up data within, the characteristics of the clinical data, the risk factor, and the blood tested in the hospital visit were analyzed for MACE (major adverse cardiac events) patients. MACE includes cardiac death, MI (myocardial infarction), Re-PCI, and CABG (coronary artery bypass graft). As a result, from the NSTEMI patients which can be followed up for over 12 m, NT-ProBNP (p=0.014) and age (p=0.045) are found to be the independent risk factors related to MACE. Accordingly, they can be useful for the diagnosis and prognosis for NSTEMI patients as a biomarker.

The Relationship Between Mean Platelet Volume and In-Hospital Mortality in Geriatric Patients with ST Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention

Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.

Staged Revascularization for Chronic Total Occlusion in the Non-IRA in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:An Updated Systematic Review and Meta-analysis

Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.

The relation between serum phosphorus levels and long-term mortality in Chinese patients with ST-segment elevation myocardial infarction

Background Elevated serum phosphorus levels may be associated with adverse outcomes in cardiovascular disease. This study aimed to investigate the relation between serum phosphorus levels and risk of all-cause mortality in Chinese patients with ST-segment elevation myocardial infarction (STEMI) who had preserved renal function at baseline. Methods We enrolled patients with STEMI who had preserved renal function at baseline in Xuanwu Hospital from January 2011 to December 2016. Those patients were divided into four groups based on serum phosphorus levels. All-cause mortality rates were compared between groups. Mean duration of follow up was 54.6 months. We used Cox proportional-hazards models to examine the relation between serum phosphorus levels and all-cause mortality after adjustment for potential confounders. Results 1989 patients were involved and 211 patients (10.6%) died during follow-up. Based on serum phosphorus levels, patients were categorized into the following groups:< 2.50 mg/dL (n = 89), 2.51–3.50 mg/dL (n = 1066), 3.51–4.50 mg/dL (n = 672) and > 4.50 mg/dL (n = 162), respectively. The lowest mortality occurred in patients with serum phosphorus levels between 2.51–3.50 mg/dL, with a multivariable-adjusted hazard ratio of 1.19 (95% CI: 0.64–1.54), 1.37 (95% CI: 1.22–1.74), and 1.46 (95% CI: 1.35–1.83) in patients with serum phosphorus levels of < 2.50 mg/dL, 3.51–4.50 mg/dL and > 4.50 mg/dL, respectively. Conclusions Elevated serum phosphorus levels were associated with all-cause mortality in Chinese patients with STEMI who had preserved renal function at baseline.

血清成纤维细胞生长因子21和脂肪酸结合蛋白4检测对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后心力衰竭的预测价值

目的探究血清成纤维细胞生长因子21(FGF21)和脂肪酸结合蛋白4(FABP4)检测对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后心力衰竭的预测价值。方法选取2020年9月至2022年9月内蒙古医科大学附属医院接诊的113例STEMI患者为研究对象,依据PCI术后1年是否发生心力衰竭(心衰),将其分为心衰组(n=32)和非心衰组(n=81)。应用ELISA法测定血清FGF21、FABP4表达水平,比较两组血清FGF21、FABP4水平,多因素logistic回归分析影响STEMI患者PCI术后发生心力衰竭的相关因素,ROC曲线评估血清FGF21、FABP4水平对STEMI患者PCI术后心力衰竭发生的预测价值。结果心衰组心率次数、C反应蛋白(CRP)、心肌肌钙蛋白(cTnI)、N末端B型利钠肽原(BNP)、利尿剂使用比例均显著高于非心衰组,左心室射血分数(LVEF)显著低于非心衰组(P<0.05)。心衰组血清FGF21、FABP4表达水平均明显高于非心衰组[(228.37±33.07)ng/L比(185.68±25.52)ng/L、(34.26±5.51)ng/ml比(26.87±4.67)ng/ml,t=7.345、7.195,P<0.05]。血清FGF21(95%CI 1.371~8.191)、FABP4(95%CI 1.176~4.090)及发病到至导丝通过时间(95%CI 1.058~8.157)是影响STEMI患者PCI术后发生心力衰竭的危险因素(OR>1,P<0.05),LVEF(95%CI 0.473~0.913)是保护因素(OR<1,P<0.05)。血清FGF21、FABP4单独及二者联合预测STEMI患者PCI术后发生心力衰竭的曲线下面积(AUC)分别为0.828、0.856、0.934,二者联合优于单一(Z二者联合-FGF21=1.971、Z二者联合-FABP4=2.417,P=0.048、P=0.015)。结论STEMI患者PCI术后发生心力衰竭血清FGF21、FABP4水平均明显升高,二者联合对STEMI患者PCI术后发生心力衰竭的风险具有更高的预测价值。

ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后左心室整体长轴应变损减对远期预后的影响

目的:评估ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后左心室整体长轴应变(GLS)损减对远期预后的影响。方法:入选2020年9月至2023年8月我院已完成罪犯血管PCI,并于住院期间完成超声心动图斑点追踪的STEMI患者156例。去除基线时心力衰竭(Killip心功能分级Ⅱ~Ⅳ级)患者18例,最终观察138例患者。应用斑点追踪技术检测GLS。根据约登指数将患者分为GLS>-11.7%组(n=57)及GLS≤-11.7%组(n=81)。比较两组患者基线资料及超声心动图特点。对患者进行21(13,28)个月的随访,比较两组患者心力衰竭事件率。结果:入院时GLS>-11.7%组患者肌钙蛋白I(TnI)峰值显著高于GLS≤-11.7%组[85 160(31 297,214 226)pg/ml vs. 34 942(13 571,92 713)pg/ml,P<0.001]、罪犯血管分布差异亦有统计学意义(P<0.001)。超声心动图显示,GLS>-11.7%组患者较GLS≤-11.7%组患者左心室射血分数(LVEF)更低[(49.2±8.3)%vs.(60.1±8.7)%,P<0.001],节段性室壁运动异常比例更高(100%vs. 90.1%,P=0.015)。随访期间GLS>-11.7%组的LVEF及GLS均有恢复趋势,但整体仍逊于GLS≤-11.7%组(P均<0.001)。中位随访21(13,28)个月期间,校正年龄、性别、罪犯血管分布、TnI峰值后,GLS>-11.7%组患者心力衰竭风险显著增加(HR=9.123,95%CI:1.720~43.394,P=0.009)。结论:STEMI患者PCI后,GLS相对损减严重的患者远期心力衰竭风险升高。

急性ST段抬高型心肌梗死合并心脏破裂的列线图模型建立

[目的]分析急性ST段抬高型心肌梗死(STEMI)患者发生心脏破裂(CR)的风险因素,并依此构建急性STEMI患者合并CR的列线图模型。[方法]通过宁夏医科大学总医院大数据研究平台、医院信息系统检索连续纳入2015年1月—2019年12月急性STEMI患者5412例,其中合并CR的91例患者为CR组,5321例未合并CR患者为非CR组。运用LASSO回归、单因素及多因素Logistic回归分析急性STEMI患者合并CR的风险因素,并建立CR的列线图预测模型。分别运用受试者工作特征曲线、Hosmer-Lemeshow检验、临床决策曲线分析法(DCA)对建立的列线图模型进行验证和评估。[结果]LASSO回归结果显示年龄、女性、高血压病史、首次医疗接触时间、休克指数、Killip分级、白细胞计数、D二聚体、乳酸、前壁心肌梗死、24 h内服用β受体阻滞剂、24 h内服用血管紧张素转化酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)药物、急诊PCI共13个变量为CR的风险因素(P<0.05)。把筛选出的13个风险因素分别进行单因素及多因素Logistic回归分析,结果提示年龄、Killip分级、首次医疗接触时间、白细胞计数、未行急诊PCI、24 h内未服用ACEI/ARB药物是急性STEMI患者合并CR的风险因素。依据上述6个风险变量建立急性STEMI合并CR列线图模型。该列线图模型内部验证前后ROC曲线下面积分别为0.946(95%CI:0.927~0.961)、0.947(95%CI:0.927~0.959),灵敏度分别为0.957、0.904,特异度分别为0.858、0.876,说明该模型具有较好的区分度。运用Hosmer-Lemeshow检验证明该模型的预测价值和实际观测值之间的偏差没有统计学意义(χ^(2)=12.70,P=0.122),说明列线图模型具有较好的校准度。DCA曲线提示模型的预测概率阈值在0.00~0.40之间,临床净获益最高,说明具有较好的临床效能。[结论]本研究建立的列线图模型有较好的区分度、校准度和临床效能,能有效预测急性STEMI合并CR的发生概率,为临床诊疗工作提供一定帮助,以期降低CR发生率。

不同剂量他汀类药物对经皮冠状动脉介入治疗的老年ST段抬高型急性心肌梗死患者的影响

目的 探讨不同剂量阿托伐他汀、瑞舒伐他汀、辛伐他汀对接受经皮冠状动脉介入治疗(PCI)的老年ST段抬高型急性心肌梗死(STEMI)患者的影响。方法 前瞻性选取接受PCI的180例STEMI患者作为研究对象,采用随机数字表法分为A组、B组、C组、D组、E组、F组,每组30例。A组口服低剂量辛伐他汀,B组口服高剂量辛伐他汀,C组口服低剂量阿托伐他汀,D组口服高剂量阿托伐他汀,E组口服低剂量瑞舒伐他汀,F组口服高剂量瑞舒伐他汀。比较各组患者血清炎症因子[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)]、心肌损伤标志物[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)、N末端脑钠肽前体(NT-proBNP)]、心功能指标[左心室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)]水平、ST段回落情况及不良心血管事件、不良反应发生情况。结果 术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的IL-6、hs-CRP、TNF-α水平均依次降低,差异有统计学意义(P<0.05);术后1 d、术后1个月时,A组、B组、C组、D组、E组、F组的cTnT、CK-MB、NT-proBNP水平均依次降低,差异有统计学意义(P<0.05);术后1个月时,A组、B组、C组、D组、E组、F组的LVEF、CO、CI均依次升高,差异有统计学意义(P<0.05);A组、B组、C组、D组、E组、F组的ST段回落者占比依次升高,差异有统计学意义(P<0.05);各组患者不良心血管事件总发生率、不良反应总发生率比较,差异均无统计学意义(P>0.05)。结论 低剂量、高剂量的阿托伐他汀、瑞舒伐他汀、辛伐他汀应用于PCI术后STEMI患者,均可有效减轻炎症反应,改善心肌功能,促进ST段回落,其中高剂量瑞舒伐他汀效果最佳。