A randomized trail comparing primary percutaneous coronary intervention with a strategy of short-acting thrombolysis and immediate planned primary percutaneous coronary intervention in acute myocardial infarction

Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.

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.

Short- and Long-term Therapeutic Efficacies of Intravenous Transplantation of Bone Marrow Stem Cells on Cardiac Function in Rats with Acute Myocardial Infarction:A Meta-analysis of Randomized Controlled Trials

Objective To investigate the short- and long-term therapeutic efficacies of intravenous transplantation of bone marrow stem cells(MSCs) in rats with experimental myocardial infarction by metaanalysis.Methods Randomized controlled trials were systematically searched from Pub Med,Science Citation Index(SCI),Chinese journal full-text database(CJFD) up to December 2014.While the experimental groups(MSCs groups) were injected MSCs intravenously,the control groups were injected Delubecco's minimum essential medium(DMEM) or phosphate buffered saline(PBS).Subgroup analysis for each outcome measure was performed for the observing time point after the transplantation of MSCs.Weighted mean differences(WMD) and 95% confidence intervals(CI) were calculated for outcome parameters including ejection fraction(EF) and fractional shortening(FS),which were measured by echocardiogram after intravenous injection and analyzed by Rev Man 5.2 and STATA 12.0.Results Data from 9 studies(190 rats) were included in the meta-analysis.As compared to the control groups,the cardiac function of the experimental groups were not improved at day 7(EF:WMD=0.08,95%CI-1.32 to 1.16,P>0.01; FS:WMD=-0.12,95%CI-0.90 to 0.65,P>0.01) until at day 14 after MSCs' transplantation(EF:WMD=10.79,95%CI 9.16 to 12.42,P<0.01; FS:WMD=11.34,95%CI 10.44 to 12.23,P<0.01),and it lasted 4 weeks or more after transplantation of MSCs(EF:WMD=13.94,95%CI 12.24 to 15.64,P<0.01; FS:WMD=9.64,95%CI 7.98 to 11.31,P<0.01).Conclusion The therapeutic efficacies of MSCs in rats with myocardid infarction become increasing apparent as time advances since 2 weeks after injection.

Effects of butyphthalide + rt-PA intravenous thrombolysis on the DWI characteristics, coagulation function and neurological function in patients with acute cerebral infarction

Objective: To investigate the effects of butyphthalide + alteplase (rt-PA) intravenous thrombolysis on the diffusion-weighted imaging (DWI) characteristics, coagulation function and neurological function in patients with acute cerebral infarction. Methods: The patients with acute cerebral infarction who were admitted to our hospital between April 2015 and October 2018 and with the onset time 4.5 hours were selected and divided into the observation group receiving butyphthalide + rt-PA intravenous thrombolysis and the control group receiving rt-PA intravenous thrombolysis by random number table. The differences in DWI parameter apparent diffusion coefficient (ADC), coagulation function indexes and neurological function indexes were compared between the two groups. Results: At 7 and 14 days after treatment, the ADC values of both groups were significantly increased, and the ADC values of the observation group were significantly higher than those of the control group;at 7 days after treatment, the prothrombin time (PT) and activated partial thromboplastin time (APTT) levels in both groups were significantly prolonged whereas fibrinogen (FIB), D-dimer (D-D), platelet activating factor (PAF), P-selectin, von Willebrand factor (vWF), neuron-specific enolase (NSE), S100B protein (S100B), malondialdehyde (MDA) and endothelin-1 (ET-1) contents were significantly decreased, and the APTT and PT levels in the observation group were significantly shorter than those in the control group whereas FIB, D-D, PAF, P-selectin, vWF, NSE, S100B, MDA and ET-1 contents were significantly lower than those in the control group. Conclusion: Butyphthalide + rt-PA intravenous thrombolysis can improve the DWI characteristics, coagulation function and neurological function of patients with acute cerebral infarction.

Anticoagulation effect of low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis for acute cerebral infarction

BACKGROUND： Studies have demonstrated that immediate anticoagulation after thrombolysis can improve the prognosis of patients with acute cerebral infarction. However, the optimal timing and means of anticoagulation therapy remain unclear. OBJECTIVE： To observe the effects and safety of heparin treatment within 24 hours after intravenous thrombolysis for acute cerebral infarction. DESIGN： Observation experiment. SETTING： Department of Neurology, the 306 Hospital of Chinese PLA. PARTICIPANTS： Fifteen acute cerebral infarction patients complicated by moderate and severe neurologic function deficits within 6 hours after attack admitted to Department of Neurology, the 306 Hospital of Chinese PLA between January 2005 and December 2006 were recruited in this study. The involved patients, 11 male and 4 female, were aged 46- 79 years. They all met the diagnosis criteria for various cerebrovascular diseases formulated by the 4th National Conference for Cerebrovascular Disease （1995） and confirmed as cerebral infarction by skull CT or MRI imageology. Informed consents were obtained from the patients or their relatives. METHODS： On admission, patients received thrombolysis with urokinase. Immediately after thrombolysis, skull CT was rechecked. Intracranial hemorrhage signs were not found by skull CT. Hemorrhage was also not found in skin, mucous membrane and internal organs. Six hours later, low-dose low-intensity heparin 4 - 8 IU/kg per hour was intravenously administrated for anticoagulation for 7 - 10 days successively. MAIN OUTCOME MEASURES： Neurologic function was evaluated before, immediately 6 hours and 14 days after thrombolysis by scoring standard of clinical neurologic function deficit degree for stroke patients （1995）. Activities of daily living of patients with stroke were evaluated 90 days after thrombolysis by modified Rankin Scale. RESULTS： Fifteen involved patients participated in the final analysis. ① Comparison of clinical neurologic function deficit degree of patients at different time： Neurologic function deficit score at the end of thrombolysis was significantly lower than that before thrombolysis （t =3.45, P 〈 0.01）. Neurologic function deficit score 6 hours after thrombolysis was higher than that at the end of thrombolysis, and neurologic deficits were increased, but no significant difference was found （P 〉 0.05）. Neurologic function deficit score 14 days after thrombolysis was significantly lower than that before thrombolysis （t =4.769, P 〈 0.01）. ②Therapeutic effect and modified Rankin scale results： 14 days after thrombolysis, 4 patients were basically cured, 7 significantly improved, 2 improved and 2 worsened. The total improvement rate of neurologic function deficit was 86.7%. Ninety days after thrombolysis, according to modified Rankin Scale, score was 0 to 2 in 12 patients （80%）, 3 to 4 in 2 patients （13.3%） and 6 in 1 patient （6.7%）. Complications of intracranial hemorrhage were not found in patients within 14 days after thrombolysis. CONCLUSION： Low-dose and low-intensity heparin applied within 24 hours after intravenous thrombolysis has good safety and efficacy in the treatment of acute cerebral infarction.

Intracranial hematoma development following thrombolysis inpatients suffering with acute myocardial infarction: Management strategy

Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.

Feasibility and efficacy of delayed pharmacoinvasive therapy for STelevation myocardial infarction

BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.

Clinical study about mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction

Objective: To explore the efficacy of mild hypothermia + intravenous thrombolysis in promoting the neural functional recovery in patients with acute cerebral infarction. Methods: A total of 176 patients with acute cerebral infarction who were treated in our hospital between September 2015 and February 2017 were reviewed and divided into the routine group (n=100 cases, receiving routine intravenous thrombolysis therapy) and the mild hypothermia group (n=76, receiving mild hypothermia + intravenous thrombolysis therapy), and the treatment lasted for 1 week. The differences in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters were compared between the two groups before treatment and after 1 week of treatment. Results: Before treatment, there was no statistically significant difference in serum levels of nerve injury indexes, inflammatory mediators and neurotransmitters between the two groups. After 1 week of treatment, serum nerve injury indexes H-FABP, NT-proBNP, NSE and S100B levels of mild hypothermia group were lower than those of routine group;inflammatory mediators sICAM-1, IL-8, IL-13 and IL-18 levels were lower than those of routine group;neurotransmitter Glu level was lower than that of routine group whereas GABA level was higher than that of routine group. Conclusion: mild hypothermia + intravenous thrombolysis therapy can effectively reduce the nerve injury and systemic inflammatory response, and optimize the neurotransmitter distribution in patients with acute cerebral infarction.

Evaluation of serological indicators of intravenous thrombolysis bridge stent combined with aspiration embolectomy for intracranial macrovascular infarction

Objective: To explore the effect of intravenous thrombolysis bridge stent combined with aspiration embolectomy on serological indicators in patients with intracranial macrovascular infarction. Methods: 92 patients with intracranial macrovascular infarction who received treatment in our hospital between February 2016 and January 2018 were selected as the research subjects and divided into the control group (n=46) and the study group (n=46) by random number table method. Control group received stent embolectomy alone, and study group received intravenous thrombolysis bridge stent combined with aspiration embolectomy. The differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were compared between the two groups before treatment and 24h after embolectomy. Results: Before treatment, the differences in serum levels of inflammatory mediators, chemokines and nerve function-related indexes were not significant between the two groups. 24h after embolectomy, serum inflammatory mediators sICAM-1, hs-CRP and TNF-α levels of study group were lower than those of control group;serum chemokines CXCL16, Fractalkine and MCP-1 contents were lower than those of control group;serum nerve function-related indexes IGF-1, BDNF and CNTF levels were higher than those of control group whereas NSE level was lower than that of control group. Conclusion:Intravenous thrombolysis bridge stent combined with aspiration embolectomy can effectively reduce the systemic inflammatory response and optimize the nerve function in patients with intracranial macrovascular infarction.

Effect of bivalirudin on myocardial microcirculation and adverse events after interventional therapy in older patients with acute coronary syndrome

BACKGROUND Bivalirudin,a direct thrombin inhibitor,is used in anticoagulation therapies as a substitute for heparin,especially during cardiovascular procedures such as percutaneous coronary intervention.AIM To explore the effect of bivalirudin on myocardial microcirculation following an intervention and its influence on adverse cardiac events in elderly patients with acute coronary syndrome(ACS).METHODS In total,165 patients diagnosed with acute myocardial at our hospital between June 2020 and June 2022 were enrolled in this study.From June 2020 to June 2022,elderly patients with ACS with complete data were selected and treated with interventional therapy.The study cohort was randomly divided into a study group(n=80,administered bivalirudin)and a control group(n=85,administered unfractionated heparin).Over a 6-mo follow-up period,differences in emergency processing times,including coronary intervention,cardiac function indicators,occurrence of cardiovascular events,and recurrence rates,were analyzed.RESULTS Significant differences were observed between the study cohorts,with the observation group showing shorter emergency process times across all stages:Emergency classification;diagnostic testing;implementation of coronary intervention;and conclusion of emergency treatment(P<0.05).Furthermore,the left ventricular ejection fraction in the observation group was significantly higher(P<0.05),and the creatine kinase-MB and New York Heart Association scores were CONCLUSION In elderly patients receiving interventional therapy for ACS,bivalirudin administration led to increased activated clotting time achievement rates,enhanced myocardial reperfusion,and reduced incidence of bleeding complications and adverse cardiac events.

Effect of transplantation of bone marrow stem cells on myocardial infarction size in a rabbit model

BACKGROUND:Intravenous transplantation has been regarded as a most safe method in stem cell therapies.There is evidence showing the homing of bone marrow stem cells(BMSCs) into the injured sites,and thus these cells can be used in the treatment of acute myocardial infarction(Ml).This study aimed to investigate the effect of intravenous and epicardial transplantion of BMSCs on myocardial infarction size in a rabbit model.METHODS:A total of 60 New Zealand rabbits were randomly divided into three groups:control group,epicardium group(group Ⅰ) and ear vein group(group Ⅱ).The BMSCs were collected from the tibial plateau in group Ⅰ and group Ⅱ,cultured and labeled.In the three groups,rabbits underwent thoracotomy and ligation of the middle left anterior descending artery.The elevation of ST segment>0.2 mV lasting for 30 minutes on the lead Ⅱ and Ⅲ of electrocardiogram suggested successful introduction of myocardial infarction.Two weeks after myocardial infarction,rabbits in group Ⅰ were treated with autogenous BMSCs at the infarct region and those in group Ⅱ received intravenous transplantation of BMSCs.In the control group,rabbits were treated with PBS following thoracotomy.Four weeks after myocardial infarction,the heart was collected from all rabbits and the infarct size was calculated.The heart was cut into sections followed by HE staining and calculation of infarct size with an image system.RESULTS:In groups Ⅰ and Ⅱ,the infarct size was significantly reduced after transplantation with BMSCs when compared with the control group(P<0.05).However,there was no significant difference in the infarct size between groups Ⅰ and Ⅱ(P>0.05).CONCLUSION:Transplantation of BMSCs has therapeutic effect on Ml.Moreover,epicardial and intravenous transplantation of BMSCs has comparable therapeutic efficacy on myocardial infarction.

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.

Effects of Intravenous Thrombolytic Therapy with Alteplase on Neurological Function,Coagulation Function and Serum Inflammatory Factors in Patients with Acute Cerebral Infarction

Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.

Early and Late Coronary Angiographic Changes After Thrombolysis in Acute Myocardial Infarciton

Objective The coronaryanatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied. Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG) was performed at 90 minuts and again at 3 to 4 weeks. Results Successful thrombolysis occurred in 60 cases, but failed in 40. The ratio of reperfusion was 60%. CAG showed there were residual thrombi in 84 patients (84% ) and complete coronary occlusion in 40(40% ). Angiography at 3 to 4 weeks after thrombolysis showed the stenosis worsened in 8 patients and improved in 10. Conclusion AMI is caused by sudden coronary thrombotic occlusion and can be reperfused by using thrombolytic agent or mechanical methods. Throm-bolytic agents usually can not resolve thrombi completely. So percutaneous transluminal coronary angiography (PTCA) is recommended as an important method to improve serious residual stenosis.

Intravenously Injected Mesenchymal Stem Cells Home to Infarcted Myocardium Without Altering Cardiac Function

Background:Systemic delivery of mesenchymal stem cells (MSCs) to the infarcted myocardium is an attractive noninvasive strategy, but therapeutic effect of this strategy remain highly controversial. Methods: Myocardial infarction was induced in female Sprague-Dawley rats by transient ligation of the left anterior descending coronary artery for 60 min. Either 2.5×106 DiI-labeled MSCs or equivalent saline was injected into the tail vein at 24 h after infarction.Results: Three days later, MSCs localized predominantly in the infarct region of heart rather than in the remote region. MSCs were also observed in spleen, lung and liver. At 4 weeks after infarction, echocardiographic parameters, including ejection fraction, fractional shortening, left ventricular end-diastolic and end-systolic diameters, were not significantly different between MSCs and saline groups. Hemodynamic examination showed that ±dp/dtmax were similar between MSCs and saline-treated animals. Histological evaluation revealed that infarct size and vessel density were not significantly changed by MSCs infusion.Conclusion: Intravenously injected MSCs can home to infarcted myocardium, but plays a limited role in cardiac repair following myocardial infarction.

Effect of Intravenous Administration of Liposomal Prostaglandin E1 on Microcirculation in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Background：Several studies have demonstrated that primary percutaneous coronary intervention （PCI） can result in reperfusion injury.This study aims to investigate the effectiveness of liposomal prostaglandin E l （Lipo-PGE1,Alprostadil,Beijing Tide Pharmaceutical Co.,Ltd.） for enhancing microcirculation in reperfusion injury.In addition,this study determined the optimal administration method for acute ST elevation myocardial infarction （STEMI） patients undergoing primary PCI.Methods：Totally,68 patients with STEMI were randomly assigned to two groups：intravenous administration ofLipo-PGE 1 （Group A）,and no Lipo-PGE1 administration （Group B）.The corrected thrombolysis in myocardial infarction （TIMI） frame count （cTFC） and myocardial blush grade （MBG） were calculated.Patients were followed up for 6 months.Major adverse cardiac events （MACE） were also measured.Results：There was no significant difference in the baseline characteristics between the two groups.The cTFC parameter in Group A was significantly lower than Group B （18.06 ± 2.06 vs.25.31 ± 2.59,P ＜ 0.01）.The ratio of final MBG grade-3 was significantly higher （P ＜ 0.05） in Group A （87.9％） relative to Group B （65.7％）.There was no significant difference between the two groups in final TIMI-3 flow and no-reflow.Patients were followed up for 6 months,and the occurrence of MACE in Group A was significantly lower than that in Group B （6.1％ vs.25.9％ respectively,P ＜ 0.05）.Conclusions：Myocardial microcirculation of reperfusion injury in patients with STEMI,after primary PCI,can be improved by administering Lipo-PGE1.

A comparative study on the effects of low dose of tPA and different regimens of intravenous urokinase in acute myocardial infarction

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Efficacy of recombinant tissue-type plasminogen activator thrombolysis and primary coronary stenting after acute myocardial infarction

Objective To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.Methods Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.Results The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P<0.001). Recurrent myocardial infarction, and selective coronary stenting of patients with thrombolytic therapy were higher than that of patients in the primary stenting group (7.6% vs 1.5%, P<0.05; 20.6% vs 0, P<0.001, respectively). Left ventricular ejection fraction (LVEF) in patients in the thrombolysis group was lower than that of the stent group (55.6%±13.4% vs 65.8%±9.2%, P<0.001). Total hospitalization time of the thrombolysis group was longer than that of the stent group (16±7 d vs 11±4 d, P<0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%, P>0.05).Conclusion Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.

Computed tomography perfusion and computed tomography angiography for prediction of clinical outcomes in ischemic stroke patients after thrombolysis

Cerebral blood perfusion and cerebrovascular lesions are important factors that can affect the therapeutic efficacy of thrombolysis.At present,the majority of studies focus on assessing the accuracy of lesion location using imaging methods before treatment,with less attention to predictions of outcomes after thrombolysis.Thus,in the present study,we assessed the efficacy of combined computed tomography（CT） perfusion and CT angiography in predicting clinical outcomes after thrombolysis in ischemic stroke patients.The study included 52 patients who received both CT perfusion and CT angiography.Patients were grouped based on the following criteria to compare clinical outcomes：（1） thrombolytic and non-thrombolytic patients,（2） thrombolytic patients with CT angiography showing the presence or absence of a vascular stenosis,（3） thrombolytic patients with CT perfusion showing the presence or absence of hemodynamic mismatch,and（4） different CT angiography and CT perfusion results.Short-term outcome was assessed by the 24-hour National Institution of Health Stroke Scale score change.Long-term outcome was assessed by the 3-month modified Rankin Scale score.Of 52 ischemic stroke patients,29 were treated with thrombolysis and exhibited improved short-term outcomes compared with those without thrombolysis treatment（23 patients）.Patients with both vascular stenosis and blood flow mismatch（13 patients） exhibited the best short-term outcome,while there was no correlation of long-term outcome with CT angiography or CT perfusion findings.These data suggest that combined CT perfusion and CT angiography are useful for predicting short-term outcome,but not long-term outcome,after thrombolysis.

The therapeutic effect and prognosis of acute cerebral infarction patients with atrial fibrillation treated by intravenous thrombolysis with recombinant tissue plasminogen activator

Objective To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in acute cerebral infarct patients with atrial fibrillation (AF) and the predicting factors of poor prognosis.Methods Totally 162 patients with acute cerebral infarct were treated with rt-PA within 4.5hours from the onset.According to past history and the electrocardiogram,the patients was classified into