BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommende...BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.展开更多
The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients w...The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after steming or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was eXPressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 = absence of activity. The scores of scanning before stenting or intravenous throm-bolysis was SBS. The scores of scaning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the steming group and thrombolysis group: SBS was 41.3+9.8 and 39.4+7.9 (t=1.2, p <0.05); SAS was 17.8+6.4 and 27.3+6.7 (t=5.8, p <0.01); SDS was 24.5+4.2 and 12.2+2.3 (t = 7.3, P <0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after steming. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between steming group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p <0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis.展开更多
Background:A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator(rhTNK-tPA)has previously shown its preliminary efficacy in ST elevation myocardial infarction(STEMI)patients.This study w...Background:A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator(rhTNK-tPA)has previously shown its preliminary efficacy in ST elevation myocardial infarction(STEMI)patients.This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase(rt-PA)in Chinese patients with STEMI.Methods:In this multicenter,randomized,open-label,non-inferiority trial,patients with acute STEMI were randomly assigned(1:1)to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min.The primary endpoint was recanalization defined by thrombolysis in myocardial infarction(TIMI)flow grade 2 or 3.The secondary endpoint was clinically justified recanalization.Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events(MACCEs)and safety endpoints.Results:From July 2016 to September 2019,767 eligible patients were randomly assigned to receive rhTNK-tPA(n=384)or rt-PA(n=383).Among them,369 patients had coronary angiography data on TIMI flow,and 711 patients had data on clinically justified recanalization.Both used a–15%difference as the non-inferiority efficacy margin.In comparison to rt-PA,both the proportion of patients with TIMI grade 2 or 3 flow(78.3%[148/189]vs.81.7%[147/180];differences:–3.4%;95%confidence interval[CI]:–11.5%,4.8%)and clinically justified recanalization(85.4%[305/357]vs.85.9%[304/354];difference:–0.5%;95%CI:–5.6%,4.7%)in the rhTNK-tPA group were non-inferior.The occurrence of 30-day MACCEs(10.2%[39/384]vs.11.0%[42/383];hazard ratio:0.96;95%CI:0.61,1.50)did not differ significantly between groups.No safety outcomes significantly differed between groups.Conclusion:rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery,a validated surrogate of clinical outcomes,among Chinese patients with acute STEMI.Trial registration:www.ClinicalTrials.gov(No.NCT02835534).展开更多
Objective To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and Emergency Department. Methods From January 1993 to December 1995, all AMI pati...Objective To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and Emergency Department. Methods From January 1993 to December 1995, all AMI patients who were admitted to the United Christian Hospital and given thrombolytic therapy were studied. The patients' demographic data, time and mode of presentation, site of myocardial infarction, treatment modality and timing, and complications related to AMI or treatment were recorded prospectively in our AMI database. The frequency of thrombolysis administered in Accident and Emergency Department and Coronary Care Unit, as well as the median door-to-needle time (time interval between hospital arrival to initiation of thrombolytic therapy) were compared. Cases of inappropriate thrombolysis and complication were also analyzed.Results Over these 3 years, 257 patients received thrombolysis in the United Christian Hospital. The percentage of patients receiving thrombolysis in Accident and Emergency Department increased from 3.2% in 1993 to 12.3% in 1994, and to 39.4% in 1995. The median time interval between arrival to hospital and thrombolysis (door-to-needle time) was 25 minutes, compared with 81 minutes in the Coronary Care Unit. The door-to-needle time also improved over these 3 years: from 95 minutes in 1993 to 75 minutes in 1995 in Coronary Care Unit group, and from 35 minutes in 1993 to 20 minutes in 1995 in the Accident and Emergency Department group. Over these 3 years, 2 cases of inappropriate thrombolysis were reported but these did not result in any mortality. Four complications from thrombolytic therapy were reported, and these were managed appropriately by the staff in Accident and Emergency Department and did not result in mortality. Conclusions Starting thrombolytic therapy in Accident and Emergency Department is safe and effectively decreases the door-to-needle time.展开更多
目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且...目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且符合入组标准的患者共183例,随机分为尿激酶组（n=91）和对照组（n=92）。尿激酶组除常规介入治疗外,在支架植入术前经抽吸导管单次或继之在PCI术中反复多次给予5-10万U尿激酶,对照组不给予尿激酶。主要观察指标包括两组患者在PCI术后即刻的TIMI血流分级、校正TIMI帧数,心电图ST段回落,以及PCI术后7、30d左室功能情况。记录30d随访的主要不良心血管事件（MACEs,包括死亡、心绞痛、靶血管再次血运重建、心衰、脑卒中）。结果尿激酶组患者在PCI术后即刻的TIMIⅢ级血流及校正TIMI帧数明显优于对照组（83 vs 71,P=0.034;21.2±10.7 vs 29.6±15.3,P=0.012）,术后90min ST段回落〉70%患者百分比明显高于对照组（93.4%vs 82.6%,P=0.025）。术后7d随访时心脏超声左室射血分数（LVEF）改善不明显（53.5%±9.4%vs 51.6%±8.7%,P=0.158）,30d时心脏超声显示,尿激酶组LVEF明显优于对照组（56.3%±9.8%vs 53.5%±8.1%,P=0.036）。30d时尿激酶组MACEs发生率明显低于对照组（4.4%vs 13.0%,P=0.038）。结论急诊PCI术中于支架植入前单次或反复多次冠脉内给予小剂量尿激酶可有效增加心肌再灌注及左室功能,改善急性心肌梗死患者的短期预后,且安全性较好。展开更多
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
文摘The theraputic effectiveness of primary coronary stenting was evaluated and compared with that of intravenous thrombolysis for acute myocardial infarction (AMI) using99m Tc-MIBI myocardial SPECT imaging. 42 patients with AMI were undergone primary coronary stenting (stenting group, 23 patients) or intravenous thrombolysis therapy (thrombolysis group, 19 patients). 99mTc-MIBI myocardium SPECT imaging was performed before and 1 week after steming or thrombolysis therapy. The left ventricular myocardium of each patient was divided into 20 segments. The semiquantitative score of myocardial 99mTc-MIBI uptake was eXPressed with a five-point scoring system: 0 = normal; 1 = equivocal; 2 = mild defect; 3 = severe defect; 4 = absence of activity. The scores of scanning before stenting or intravenous throm-bolysis was SBS. The scores of scaning after stenting or intravenous thrombolysis was SAS. Deducting SAS from SBS was SDS. A comparison was made between the steming group and thrombolysis group: SBS was 41.3+9.8 and 39.4+7.9 (t=1.2, p <0.05); SAS was 17.8+6.4 and 27.3+6.7 (t=5.8, p <0.01); SDS was 24.5+4.2 and 12.2+2.3 (t = 7.3, P <0.01). In the 193 defect segments before stenting, 106 segments (54.9%) restored to normal after steming. In the 149 defect segments before intravenous thrombolysis, 61 segments (40.9%) restored to normal after thrombolysis therapy. Comparing between steming group and thrombolysis group in the improved rate of myocardial perfusion defect scores there was a significant difference (p <0.01). 99mTc-MIBI myocardial SPECT imaging has been proved to be an objective parameter for evaluating the therapeutic effectiveness of the stenting and the intravenous thrombolysis in the treatment of AMI. The results indicated that primary coronary stenting seems to be more effective than intravenous thrombolysis.
基金supported by the Guangzhou Recomgen Biotech Co.,Ltd.The funder had no role in the design and conduct of the studycollection,management,analysis,and interpretation of the data
文摘Background:A phase II trial on recombinant human tenecteplase tissue-type plasminogen activator(rhTNK-tPA)has previously shown its preliminary efficacy in ST elevation myocardial infarction(STEMI)patients.This study was designed as a pivotal postmarketing trial to compare its efficacy and safety with rrecombinant human tissue-type plasminogen activator alteplase(rt-PA)in Chinese patients with STEMI.Methods:In this multicenter,randomized,open-label,non-inferiority trial,patients with acute STEMI were randomly assigned(1:1)to receive an intravenous bolus of 16 mg rhTNK-tPA or an intravenous bolus of 8 mg rt-PA followed by an infusion of 42 mg in 90 min.The primary endpoint was recanalization defined by thrombolysis in myocardial infarction(TIMI)flow grade 2 or 3.The secondary endpoint was clinically justified recanalization.Other endpoints included 30-day major adverse cardiovascular and cerebrovascular events(MACCEs)and safety endpoints.Results:From July 2016 to September 2019,767 eligible patients were randomly assigned to receive rhTNK-tPA(n=384)or rt-PA(n=383).Among them,369 patients had coronary angiography data on TIMI flow,and 711 patients had data on clinically justified recanalization.Both used a–15%difference as the non-inferiority efficacy margin.In comparison to rt-PA,both the proportion of patients with TIMI grade 2 or 3 flow(78.3%[148/189]vs.81.7%[147/180];differences:–3.4%;95%confidence interval[CI]:–11.5%,4.8%)and clinically justified recanalization(85.4%[305/357]vs.85.9%[304/354];difference:–0.5%;95%CI:–5.6%,4.7%)in the rhTNK-tPA group were non-inferior.The occurrence of 30-day MACCEs(10.2%[39/384]vs.11.0%[42/383];hazard ratio:0.96;95%CI:0.61,1.50)did not differ significantly between groups.No safety outcomes significantly differed between groups.Conclusion:rhTNK-tPA was non-inferior to rt-PA in the effect of improving recanalization of the infarct-related artery,a validated surrogate of clinical outcomes,among Chinese patients with acute STEMI.Trial registration:www.ClinicalTrials.gov(No.NCT02835534).
文摘Objective To evaluate the effectiveness of initiating thrombolysis for patients with acute myocardial infarction (AMI) in the Accident and Emergency Department. Methods From January 1993 to December 1995, all AMI patients who were admitted to the United Christian Hospital and given thrombolytic therapy were studied. The patients' demographic data, time and mode of presentation, site of myocardial infarction, treatment modality and timing, and complications related to AMI or treatment were recorded prospectively in our AMI database. The frequency of thrombolysis administered in Accident and Emergency Department and Coronary Care Unit, as well as the median door-to-needle time (time interval between hospital arrival to initiation of thrombolytic therapy) were compared. Cases of inappropriate thrombolysis and complication were also analyzed.Results Over these 3 years, 257 patients received thrombolysis in the United Christian Hospital. The percentage of patients receiving thrombolysis in Accident and Emergency Department increased from 3.2% in 1993 to 12.3% in 1994, and to 39.4% in 1995. The median time interval between arrival to hospital and thrombolysis (door-to-needle time) was 25 minutes, compared with 81 minutes in the Coronary Care Unit. The door-to-needle time also improved over these 3 years: from 95 minutes in 1993 to 75 minutes in 1995 in Coronary Care Unit group, and from 35 minutes in 1993 to 20 minutes in 1995 in the Accident and Emergency Department group. Over these 3 years, 2 cases of inappropriate thrombolysis were reported but these did not result in any mortality. Four complications from thrombolytic therapy were reported, and these were managed appropriately by the staff in Accident and Emergency Department and did not result in mortality. Conclusions Starting thrombolytic therapy in Accident and Emergency Department is safe and effectively decreases the door-to-needle time.
文摘目的探讨急诊经皮冠状动脉介入术（PCI）中冠状动脉内小剂量尿激酶溶栓联合支架植入对急性ST段抬高型心肌梗死（STEMI）患者心肌灌注及短期预后的影响。方法选择2011年10月-2013年6月在解放军306医院因急性STEMI接受急诊PCI手术治疗且符合入组标准的患者共183例,随机分为尿激酶组（n=91）和对照组（n=92）。尿激酶组除常规介入治疗外,在支架植入术前经抽吸导管单次或继之在PCI术中反复多次给予5-10万U尿激酶,对照组不给予尿激酶。主要观察指标包括两组患者在PCI术后即刻的TIMI血流分级、校正TIMI帧数,心电图ST段回落,以及PCI术后7、30d左室功能情况。记录30d随访的主要不良心血管事件（MACEs,包括死亡、心绞痛、靶血管再次血运重建、心衰、脑卒中）。结果尿激酶组患者在PCI术后即刻的TIMIⅢ级血流及校正TIMI帧数明显优于对照组（83 vs 71,P=0.034;21.2±10.7 vs 29.6±15.3,P=0.012）,术后90min ST段回落〉70%患者百分比明显高于对照组（93.4%vs 82.6%,P=0.025）。术后7d随访时心脏超声左室射血分数（LVEF）改善不明显（53.5%±9.4%vs 51.6%±8.7%,P=0.158）,30d时心脏超声显示,尿激酶组LVEF明显优于对照组（56.3%±9.8%vs 53.5%±8.1%,P=0.036）。30d时尿激酶组MACEs发生率明显低于对照组（4.4%vs 13.0%,P=0.038）。结论急诊PCI术中于支架植入前单次或反复多次冠脉内给予小剂量尿激酶可有效增加心肌再灌注及左室功能,改善急性心肌梗死患者的短期预后,且安全性较好。
