Sevoflurane Versus Propofol for Myocardial Protection in Patients Undergoing Coronary Artery Bypass Grafting Surgery: a Meta-analysis of Randomized Controlled Trials

Objective To systematically review randomized controlled trials to compare myocardial protection profiles of sevoflurane with propofol in patients undergoing coronary artery bypass grafting (CABG) surgery. Methods Electronic databases were searched to identify all randomized controlled trials comparing sevoflurane with propofol for protecting myocardium in adult patients undergoing CABG surgery. Two authors independently extracted patients' perioperative data, including patients' baseline characteristics, surgical variables, and outcome data. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio (OR) and 95% CI. Each outcome was tested for heterogeneity, and randomized-effects or fixed-effects model was used in the presence or absence of significant heterogeneity (Q test P<0.05). Sensitivity analyses were done by examining the influence of statistical model on estimated treatment effects. Publication bias was explored through visual inspection of funnel plots of the outcomes. Statistical significance was defined as P<0.05. Results Our search yielded 13 studies including 696 patients, and 402 patients were allocated into sevoflurane group and 294 into propofol group. There was no significant difference in postoperative mechanical ventilation time, inotropic support, mortality, myocardial infarction, and atrial fibrillation between the two groups (all P>0.05). Patients randomized into sevoflurane group had higher post-bypass cardiac index (WMD=0.39, 95% CI: 0.18 to 0.60, P=0.0003), lower troponin I level (WMD=-0.82, 95% CI:-0.87 to-0.85, P=0.0002), lower incidence of myocardial ischemia (OR=0.37, 95% CI: 0.16 to 0.83, P=0.02), shorter ICU and hospital stay length (WMD=-10.99, 95% CI:-12.97 to-9.01, P<0.00001; WMD=-0.78, 95% CI:-1.00 to-0.56, P<0.00001, respectively). Conclusion This meta-analysis has found some evidence showing that sevoflurane has better myocardial protection than propofol in CABG surgery.

Clinical Efficacy of Recombinant Brain Natriuretic Peptide in Patients with Acute Myocardial Infarction After On-Pump Coronary Artery Bypass Grafting (CABG)

Objective:To evaluate the clinical efficacy of intravenous recombinant human brain natriuretic peptide(rhBNP)in patients with acute myocardial infarction after on-pump coronary artery bypass grafting(CABG).Methods:40 cases of coronary heart disease,left ventricular ejection fraction<50%and(plasma brain natriuretic peptide in type N terminal)NT-proBNP>300 pg/ml underwent on-pump coronary artery bypass surgery with cardiopulmonary bypass were enrolled and randomly divided into two groups,experimental group of 20 patients after operation on the basis of conventional therapy plus recombinant human brain natriuretic peptide treatment(first loading dose of 1.5μg/kg intravenously,to maintain dose of 0.01μg/kg/min continuous infusion of 72h),20 cases of the control group was given routine treatment,observe two groups of patients before and after treatment of blood pressure,heart rate,urine volume,blood creatinine and NT-proBNP,and to observe the left ventricular ejection fraction(LVEF),echocardiography and the length of time the index.Results:the experimental group after treatment,urine volume,left ventricular ejection fraction(LVEF),cardiac index(CI)was significantly higher than that before treatment,the serum creatinine,plasma N-terminal pro brain natriuretic peptide(NTproBNP),the content of serum troponin T peptide(cT nT),creatine kinase isoenzyme(CK MB)was significantly lower than before treatment.Conclusion:Recombinant human brain natriuretic peptide can improve cardiac and renal function in patients with acute period of acute myocardial infarction underwent coronary artery bypass surgery,shorten the hospitalization time,and it is safe and feasible.

Off-pump coronary artery bypass grafting: Misperceptions and misconceptions

Coronary artery bypass grafting(CABG) continues to be one of the most commonly performed cardiac surgical procedures worldwide. Conventional CABG performed on cardiopulmonary bypass termed on-pump CABG is regarded as the gold standard. However, on-pump CABG results in several physiologic derangements including but not limited to thrombocytopenia, activation of complement factors, immune suppression, and inflammatory responses leading to organ dysfunction.Furthermore, manipulating an atherosclerotic ascending aorta during cannulation and cross-clamping can predispose to embolization and stroke risk. Recognition of these detrimental effects of on-pump CABG resulted in resurgence of off-pump CABG nearly two decades ago.Off-pump CABG since its resurgence has been a subject of intensive scrutiny and speculation. Despite numerous retrospective nonrandomized studies, prospective randomized trials, and meta-analyses validating the safety and efficacy of off-pump CABG, opponents of the technique have persistently demanded abandonment of off-pump CABG. Several misconceptions and misperceptions are used as an excuse for such demands. This review article examines published scientific evidence to evaluate these misperceptions and misconceptions about off-pump CABG.

Anesthetic considerations for the patients with off-pump coronary artery bypass grafting

New surgical techniques for coronary artery bypass graft （CABG） have been explored in order to minimize disfiguring scars, avoid cardiopulmonary bypass and decrease hospital residence and costs etc. Improved surgical expense can perform the procedures in some high-risk patients such as poor left ventricular function, redo CABG, advanced age and renal dysfunction etc. Intraoperatively there is an obligatory period of myocardial ischemia, which may lead to significant hemodynamic consequences. It is a quite challenge to anesthetist in managing the intraoperative patient.

Physiology of in-situ arterial revascularization in coronary artery bypass grafting: Preoperative,intraoperative and postoperative factors and influences

Surgical revascularization with coronary artery bypass grafting(CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease(SIHD). This recommendation is based on traditional 5-year outcomes of mortality and avoidance of myocardial infarction leading to reintervention and/or cardiac death. However, these results are confounded in that they challenge the traditional CABG surgical tenets of completeness of anatomic revascularization, the impact of arterial revascularization on late survival, and the lesser impact of secondary prevention following CABG on late outcomes. Moreover, the emergence of physiologic-based revascularization with percutaneous cardiovascular intervention as an alternative strategy for revascularization in SIHD raises the question of whether there are similar physiologic effects in CABG. Finally, the ongoing ISCHEMIA trial is specifically addressing the importance of the physiology of moderate or severe ischemia in optimizing therapeutic interventions in SIHD. So it is time to address the role that physiology plays in surgical revascularization. The long-standing anatomic framework for surgical revascularization is no longer sufficient to explain the mechanisms for short-term and long-term outcomes in CABG. Novel intraoperative imaging technologies have generated important new data on the physiologic blood flow and myocardial perfusion responses to revascularization on an individual graft and global basis. Long-standing assumptions about technical issues such as competitive flow are brought into question by real-time visualization of the physiology of revascularization. Our underestimation of the impact of Guideline Directed Medical Therapy, or Optimal Medical Therapy, on the physiology of preoperative SIHD, and the full impact of secondary prevention on post-intervention SIHD, must be better understood. In this review, these issues are addressed through the perspective of multi-arterial revascularization in CABG, which is emerging(after 30 years) as the "standard of care" for CABG. In fact, it is the physiology of these arterial grafts that is the mechanism for their impact on long-term outcomes in CABG. Moreover, a better understanding of all of these preoperative, intraoperative and postoperative components of the physiology of revascularization that will generate the next, more granular body of knowledge about CABG, and enable surgeons to design and execute a better surgical revascularization procedure for patients in the future.

Effect of coronary artery revascularization on in-hospital outcomes and long-term prognoses in acute myocardial infarction patients with prior ischemic stroke

ObjectiveTo 调查冠的动脉 revascularization 治疗(大车)，包括的经皮的冠的干预(一种总线标准)和冠的动脉是否绕过 grafting ( CABG )，能为有优先的 ischemic 的病人摸的尖锐心肌的梗塞( AMI )改进在里面医院和长期的结果() 387 个 AMI 病人与的 .MethodsA 总数优先在这队研究从2005年1月15日连续地被注册到2011年12月24日。所有病人被分成 CART 组(n = 204 ) 或保守的药(厘米) 组(n = 183 ) 。在里面医院 cardiocerebral 事件和在 36 个月的平均后续以后的二个组的长期的死亡被 Kaplan-Meier 幸存曲线记录并且由逻辑回归和艇长回归 model.ResultsThe 大车病人比较了更年轻(66.5 &#x000b1；9.7 年对 71.7 &#x000b1；9.7 年， P &#x0003c；0.01 ) ，有更少的非圣片断举起心肌的梗塞(11.8% 对 20.8% ， P = 0.016 ) 并且更多重脉管的冠的损害(50% 对 69.4% ， P = 0.031 ) 。当 26.2% 在 CM 组织时，在 CART 组的 cardiocerebral 事件的住院发生是 9.3%(P &#x0003c；0.01 ) 。大车显著地在 65% 减少了在里面医院 cardiocerebral 事件的风险[调整机会比率(或)= 0.35， 95% CI：0.13-0.92 ] 。在后续底， 57 个盒子(41.6%) 在厘米组死了(n = 137 ) 并且 24 个盒子(12.2%) 在大车组死了(n = 197 ) 。考克斯回归显示那辆大车减少了在 72% 的长期的死亡[调整危险比率(HR )= 0.28， 95% CI：0.06-0.46 ] ，当范畴的分析显示了时，一种总线标准和 CABG.ConclusionsCART 之间的重要差别都没在为 AMI 病人改进在里面医院和长期的预测与上有重要效果优先。

Comprehensive assessment of a post-coronary bypass graft patient with cardiovascular magnetic resonance imaging and multi-detector computed tomography

Coronary bypass graft surgery (CABG) is a revascularization procedure which reduces myocardial ischemia and cardiovascular morbidity and mortality in selected patients;however, up to 40% of saphanous vein grafts may degenerate over 10 years. Although coronary angiography is the gold standard to detect graft patency and native vessel disease, sometimes it is difficult to locate the grafts resulting in increased exposure to radiation and contrast administration. This case highlights the utility of cardiac computerized tomography and magnetic resonance imaging to provide comprehensive noninvasive assessment in a patient post CABG.(J Geriatr Cardiol 2007;4:244-247.)

右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术患者血流动力学、心肌保护效应及术后转归的影响

目的探讨右美托咪定辅助全身麻醉对老年非体外循环冠状动脉搭桥术(CABG)患者血流动力学、心肌保护效应及术后转归的影响。方法前瞻性选取2021年6月至2023年6月邯郸市第一医院收治的110例非体外循环CABG患者,采用随机数字表法分为观察组和对照组,各55例。观察组给予右美托咪定辅助全身麻醉(麻醉诱导前15 min静滴0.6μg/kg,以0.2~0.4μg·kg^(-1)·h^(-1)持续泵注至手术结束),对照组给予等体积0.9%氯化钠溶液,其余同观察组。比较两组患者麻醉前(T_(0))、穿刺完毕5 min(T_(1))、手术结束即刻(T_(2))与手术后12 h(T_(3))的围手术期血流动力学指标[血氧饱和度(SpO_(2))与平均动脉压(MAP)、心率],手术前、手术后24、48 h的心肌损伤标志物[肌钙蛋白T(CTnT)和肌酸激酶同工酶(CK-MB)],手术前、手术后6、12、24 h的认知功能[蒙特利尔认知评估量表(MoCA)评分],术后转归情况(气管拔管、ICU滞留、苏醒、定向力恢复与术后住院时间)及躁动发生率。结果T_(0)时,两组SpO_(2)、MAP、心率比较,差异均无统计学意义(P>0.05);T_(1)、T_(2)、T_(3)时,观察组SpO_(2)、MAP、心率均高于对照组,差异均有统计学意义(P<0.05)。手术后24、48 h,观察组的cTnT和CK-MB水平均低于对照组,差异均有统计学意义(P<0.05)。手术后6、12、24 h,观察组的MoCA评分分别为(26.65±1.41)、(27.58±1.11)、(28.69±1.15)分,均高于对照组[(25.31±1.22)、(26.47±1.23)、(27.11±1.24)分],差异均有统计学意义(P<0.05)。两组苏醒时间、定向力恢复时间比较,差异均无统计学意义(P>0.05),观察组气管拔管时间、ICU滞留时间、术后住院时间分别为(15.86±3.36)h、(51.39±5.77)h、(11.39±2.48)d,均短于对照组[(19.75±3.41)h、(60.48±5.63)h、(13.65±2.61)d],差异均有统计学意义(P<0.05)。手术后6、24、48 h,观察组患者的躁动发生率分别为5.45%、3.64%、1.82%,均低于对照组(21.82%、16.36%、14.55%),差异均有统计学意义(P<0.05)。结论右美托咪定辅助全身麻醉在老年非体外循环冠脉搭桥术患者中可稳定患者围术期血流动力学,减少心肌损害,改善患者早期认知功能,同时可促进患者术后转归,降低术后躁动发生率。

右美托咪定复合罗哌卡因胸椎旁神经阻滞对冠状动脉搭桥术后心肌再灌注损伤及恢复质量的影响

目的研究右美托咪定复合罗哌卡因胸椎旁神经阻滞对冠状动脉搭桥术后心肌再灌注损伤及恢复质量的影响。方法前瞻性选取2021年3月至2023年2月邯郸市中心医院收治的97例行冠状动脉搭桥术的患者作为研究对象,采用掷硬币法将其分为观察组(n=49)和对照组(n=48)。两组患者均在全身麻醉下手术,对照组采用0.5%罗哌卡因20 mL进行胸椎旁神经阻滞,观察组采用0.75μg/kg右美托咪定+0.5%罗哌卡因20 mL进行胸椎旁神经阻滞。比较两组患者麻醉前、气管插管即刻、切皮后5 min、术毕的平均动脉压(MAP)、心率;记录两组患者的手术时间、术后机械通气时间、拔管时间、苏醒时间、ICU滞留时间及住院时间;比较两组患者手术后12、24 h的疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分,手术前、手术后24 h的肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、天冬氨酸转移酶(AST)水平,以及补救镇痛及并发症发生情况。结果麻醉前及气管插管即刻,两组MAP、心率比较,差异均无统计学意义(P>0.05);切皮后5 min及术毕,观察组MAP、心率均低于对照组,差异均有统计学意义(P<0.05)。两组手术时间、术后机械通气时间及苏醒时间比较,差异均无统计学意义(P>0.05);观察组ICU滞留时间、拔管时间及住院时间分别为(16.58±4.03)h、(5.47±1.23)h、(11.24±2.10)d,均短于对照组[(18.33±4.52)h、(6.02±1.39)h、(12.17±2.38)d],差异均有统计学意义(P<0.05)。手术后12、24 h,观察组VAS评分分别为(2.65±0.45)、(2.56±0.59)分,均低于对照组[(2.87±0.53)、(2.92±0.61)分],Ramsay镇静评分分别为(2.15±0.95)、(2.20±0.91)分,均高于对照组(1.63±0.72)、(1.60±0.68)分,差异均有统计学意义(P<0.05)。手术后24 h,两组cTnI、CK-MB及AST水平均较手术前升高,但观察组cTnI、CK-MB及AST水平分别为(0.96±0.31)ng/mL、(4.91±1.06)ng/mL、(39.08±7.26)U/L,均低于对照组[(1.16±0.34)ng/mL、(5.61±1.17)ng/mL、(43.14±8.34)U/L],差异均有统计学意义(P<0.05)。两组术后补救镇痛发生率与总并发症发生率比较,差异均无统计学意义(P>0.05)。结论右美托咪定复合罗哌卡因胸椎旁神经阻滞应用于冠状动脉搭桥术,患者术后恢复更快,镇静效果更好,可显著减轻患者术后疼痛,对患者心肌再灌注损伤更小。

介入治疗策略对冠状动脉搭桥术后急性心肌梗死患者预后的影响观察

目的:观察介入治疗策略对冠状动脉搭桥术(CABG)术后急性心肌梗死患者预后的影响。方法:选取2017年6月—2020年6月泰达国际心血管病医院CABG术后超过1个月的70例急性心肌梗死患者作为研究对象,将其分为原位冠状动脉治疗组40例和桥血管治疗组30例。收集临床资料,并进行2年随访,观察两组患者心血管事件发生情况。结果:原位冠状动脉治疗组患者的CABG术后时间短于桥血管治疗组患者,差异有统计学意义(t=2.111,P<0.05)。2年随访有31例(44.3%)患者发生心血管事件。经Log-rank检验,原位冠脉治疗组患者事件发生率低于桥血管治疗组患者,差异有统计学意义(P<0.05)。Cox回归分析结果显示,采用原位冠状动脉介入治疗较桥血管介入治疗可降低2年心血管事件发生率(HR=0.350,95%CI:0.167~0.733,P<0.05)。结论:对CABG术后急性心肌梗死患者采用原位冠状动脉介入治疗较桥血管介入治疗可减少心血管事件的发生,改善预后。

Gender gap in acute coronary heart disease:Myth or reality?

AIM: To investigate potential gender differences in the prevalence of cardiovascular risk factors, cardiovascular disease (CVD) management, and prognosis in acute coronary syndrome (ACS). METHODS: A systematic literature search was performed through Medline using pre-specified key words . An additional search was performed, focusing specifically on randomized controlled clinical trials in relation to therapeutic intervention and prognosis. In total, 92 relevant articles were found. RESULTS: Women with CVD tended to have more hypertension and diabetes at the time of presentation, whereas men were more likely to smoke. Coronary angiography and revascularization by percutaneous coronary intervention were performed more often in men. Women were at a greater risk of short-term mortality and complications after revascularization. Interestingly, women under 40 years presenting with ACS were athighest risk of cardiovascular death compared with men of the same age, irrespective of risk factors. This disadvantage disappeared in older age. The long-term mortality risk of ACS was similar in men and women, and even in favor of women. CONCLUSION: Mortality rates are higher among young women with ACS, but this difference tends to disappear with age, and long-term prognosis is even better among older women.

Passive graft perfusion in off-pump coronary artery bypass grafting

Background Myocardial protection during off-pump coronary artery bypass grafting （OPCABG） is a multifactorial problem in which maintaining stable systemic hemodynamics is very important. In this study passive graft perfusion （PGP） was applied to investigate the effect during and after OPCABG as evaluated by cardiac troponin I （CTnl） and hemodynamic indexes. Methods Thirty first-time patients underwent OPCABG under one surgeon. They were randomly divided into two groups： The passive graft perfusion group （PGP, n=15） received distal coronary perfusion during the anastomosis and immediate graft perfusion after the distal anastomosis. The control group, no graft perfusion group, （NGP, n=15） received no graft perfusion after the distal anastomosis. The results of the two protocols were evaluated by concentration of CTnl and hemodynamic indexes before induction and after operation. Results There were no statistically significant differences between these two groups in their perioperation parameters. The level of CTnl increased postoperatively, reached its peak at 6 hours （P〈0.05） and recovered by the 6 days postoperative. Compared with the control group the concentration of CTnl in the PGP group was significantly lower at 6 and 24 hours （P〈0.01）. Compared with the NGP group, cardiac index （CI） in the PGP group was higher at 12 and 24 hours after operation （P〈0.05）. The period of mechanical ventilation was significantly shorter in the PGP group than in the NGP group （P〈0.05）. Conclusion PGP can increase the flow to the myocardium and shorten the heart ischemia time, thus maintain stable systemic hemodynamics, supply a satisfactory CI after surgery and improve surgery outcome.

Coronary artery bypass grafting for Kawasaki disease

Background Kawasaki disease （KD） is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting （CABG） in patients with KD. Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient （mean 2.5±0.8）. Various bypass grafts were used in patients, i.e. the left internal mammary artery （LIMA） in 3 patients, bilateral internal mammary artery （IMA） in 2 patients, LIMA plus gastroepiploic artery （GEA） in 1 patient and total saphenous vein grafts （SVGs） in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass （CPB）, after being supported with intra-aortic balloon pump （IABP）, the patient was weaned from CPB successfully. Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months （mean 27 months）, clincal angina disappeared or improved. Cardiac function was in Class I-II （NYHA）.Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

Impact of gout on in-hospital outcomes of acute coronary syndrome-related hospitalizations and revascularizations: Insights from the national inpatient sample

BACKGROUND Previous studies have established a role of gout in predicting risk and prognosis of cardiovascular diseases. However, large-scale data on the impact of gout on inpatient outcomes of acute coronary syndrome (ACS)-related hospitalizations and post-revascularization is inadequate. AIM To evaluate the impact of gout on in-hospital outcomes of ACS hospitalizations, subsequent healthcare burden and predictors of post-revascularization inpatient mortality. METHODS We used the national inpatient sample (2010-2014) to identify the ACS and goutrelated hospitalizations, relevant comorbidities, revascularization and postrevascularization outcomes using the ICD-9 CM codes. A multivariable analysis was performed to evaluate the predictors of post-revascularization in-hospital mortality. RESULTS We identified 3144744 ACS-related hospitalizations, of which 105198 (3.35%) also had gout. The ACS-gout cohort were more often older white males with a higher prevalence of comorbidities. Coronary artery bypass grafting was required more often in the ACS-gout cohort. Post-revascularization complications including cardiac (3.2% vs 2.9%), respiratory (3.5% vs 2.9%), and hemorrhage (3.1% vs 2.7%) were higher whereas all-cause mortality was lower (2.2% vs 3.0%) in the ACSgout cohort (P < 0.001). An older age (OR 15.63, CI: 5.51-44.39), non-elective admissions (OR 2.00, CI: 1.44-2.79), lower household income (OR 1.44, CI: 1.17- 1.78), and comorbid conditions predicted higher mortality in ACS-gout cohort undergoing revascularization (P < 0.001). Odds of post-revascularization inhospital mortality were lower in Hispanics (OR 0.45, CI: 0.31-0.67) and Asians (OR 0.65, CI: 0.45-0.94) as compared to white (P < 0.001). However, postoperative complications significantly raised mortality odds. Mean length of stay, transfer to other facilities, and hospital charges were higher in the ACS-gout cohort. CONCLUSION Although gout was not independently associated with an increased risk of postrevascularization in-hospital mortality in ACS, it did increase postrevascularization complications.

Long-term outcome of native artery versus bypass graft intervention in prior coronary artery bypass graft patients with ST-segment elevation myocardial infarction

Background Patients with prior coronary artery bypass graft （CABG） have a poor outcome after acute myocardial infarction （AMI）.Little is known about the treatment strategy and outcome of percutaneous coronary intervention （PCI） in these patients.The purpose of this study was to investigate the impact of graft versus native artery PCI on the outcomes of prior CABG patients with AMI.Methods Between September 2005 and October 2011,a total of 140 consecutive patients with previous CABG undergoing PCI for the treatment of AMI were included.Clinical/procedural characteristics and long-term clinical outcomes were compared between graft and native artery PCI patients.Results The mean time interval to prior CABG was （5.6±4.2） years.Thirty patients received graft PCI,success rate being 90%.One hundred and ten patients received native artery PCI,success rate being 90.7% （P 〉0.05）.There were no significant differences in the basic characteristics between the two groups.All patients received drug eluting stents （DESs）.Three patients died during hospitalization in the graft-PCI group （10% vs.native PCI 0,P 〈0.05）.After a median followup of two years,major adverse cardiac events （MACE） （myocardial infarction,target vessel revascularization,total death） were 20% with no significant difference between the two groups.Cox regression analysis showed that both diabetes mellitus （DM,HR 3.57,95% CI 1.03-5.75,P 〈0.05） and primary PCI （HR 5.932,95% Cl 1.91-18.4,P 〈0.05） were independent predictors of MACE.Conclusions More patients with prior CABG underwent native artery PCI for AMI.PCI to culprit graft vessels had higher in-hospital mortality.DM and primary PCI,but not graft PCI,were predictors for adverse long-term outcome.

Typical rise and fall of troponin in(peri-procedural) myocardial infarction:A systematic review

AIM: To identify the typical shape of the rise and fall curve of troponin(Tn) following the different types of myocardial infarction(MI). METHODS: We conducted a systematic search in PubM ed and Embase including all studies which focused on the kinetics of Tn in MI type 1, type 4 and type 5. Tn levels were standardized using the 99 th percentile, a pooled mean with 95%CI was calculated from the weighted means for each time point until 72 h. RESULTS: A total of 34 of the 2528 studies identified in the systematic search were included. The maximum peak level of the Tn was seen after 6 h after successful reperfusion of an acute MI, after 12 h for type 1 MI and after 72 h for type 5 MI. In type 1 MI there were additional smaller peaks at 1 h and at 24 h. After successful reperfusion of an acute MI there was a second peak at 24 h. There was not enough data available to analyze the Tn release after MI associated with percutaneous coronary intervention(type 4).CONCLUSION: The typical rise and fall of Tn is different for type 1 MI, successful reperfusion of an acute MI and type 5 MI, with different timing of the peak levels and different slopes of the fall phase.

Similar long-term outcome for arterial myocardial revascularization performed after or within the first seven day of acute myocardial infarction

The current practice of myocardial revascularization for acute myocardial infarction (MI) is primary percutaneous intervention (PCI). Surgical revascularization (“bypass”) is reserved for patients unsuitable for PCI. The purpose of this report is to describe the long-term outcome of acute MI patients who underwent left-sided arterial revascularization (left anterior descending and circumflex arteries) before PCI was adopted as the preferred treatment for this subset of patients. Between 1996 and 2002, 434 consecutive patients in our center underwent myocardial revascularization for recent MI using the composite T-graft technique (381 bilateral internal thoracic arteries and 53 single internal thoracic artery and radial arteries). Two-hundred and seventy-six patients were operated on within seven days of an acute MI (Group A) and the remaining 158 patients were operated on after the 7th day since an acute MI (Group B). Group A had significantly increased operative mortality (6.5% vs 1.3% for Group B, P = 0.012). Surgery performed within the first week of an acute MI was also found to be a significant predictor of early mortality in multivariate logistic regression analysis (O.R. 10.31;95% C.I. 1.32-83.30, P = 0.026). The mean follow-up was 10.6 ± 5.2 years. The Kaplan Meier 10-year survival of the two groups, however, was similar (65.6 ± 2.9 Group A vs 64.6 ± 3.8 Group B, P = 0.953), and assignment to Group A was not an independent predictor of decreased survival (P = 0.395, Cox model). When using arterial grafts for myocardial revascularization, the long-term outcome of patients operated on during the first 7 days of acute MI is not worse than that of patients operated on after more than 7 days, despite their increased operative mortality.

尼可地尔对冠状动脉旁路移植术患者术后心肌微循环及心肌损伤的影响

目的观察尼可地尔对冠状动脉旁路移植术(CABG)患者术后心肌微循环及心肌损伤的影响。方法按照随机数字表法将2018年12月—2022年12月贵州省人民医院行CABG治疗患者68例分为对照组和观察组,各34例。对照组患者给予常规治疗,观察组在对照组基础上予以尼可地尔治疗,2组均治疗1个月。比较2组TIMI血流分级,术前及术后1个月心肌微循环评价指标[左前降支(LAD)、左回旋支(LCX)、右冠脉(RCA)校正的TIMI血流帧数(cTFC)]、心功能指标[左心室射血分数(LVEF)、左心室收缩期末期内径(LVESD)、左心室舒张末期内径(LVEDD)]、心肌损伤标志物[N末端脑钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)及心肌肌钙蛋白I(cTnI)]及不良反应。结果术后1个月,观察组TIMI血流分级优于对照组(u=2.338,P=0.019);2组LAD、LCX、RCA的cTFC均较术前减小,且观察组小于对照组(P<0.05或P<0.01);2组LVEF高于术前,LVESD、LVEDD小于术前,且观察组LVEF高于对照组,LVESD、LVEDD小于对照组(P<0.05或P<0.01);2组血浆NT-proBNP、CK-MB、cTnI水平低于术前,且观察组低于对照组(P<0.05或P<0.01)。观察组与对照组不良反应总发生率比较,差异无统计学意义(14.71%vs.8.82%,χ^(2)=0.142,P=0.707)。结论尼可地尔可有效调节CABG患者术后心肌微循环,改善心功能,增加血流灌注,减轻心肌损伤,且不良反应少。

基于WGCNA和机器学习方法筛选冠脉搭桥术后氧化应激相关的核心基因

目的 利用加权基因共表达网络分析(WGCNA)和机器学习方法,筛选出冠脉搭桥(CABG)术后氧化应激(OS)相关的核心基因,并预测治疗心肌缺血再灌注损伤(MIRI)的靶向药物。方法 从GEO数据库CABG术前、术后心室组织表达谱,利用WGCNA得到术后最关联模块和基因,从而获得OS相关基因(OSRG),进一步富集分析。再通过最小绝对值收敛和选择算子(LASSO)回归和随机森林算法,筛选出冠脉搭桥术后核心OSRG,术前术后差异表达比较,预测靶向药物。结果 WGCNA结果得到32个CABG术后OSRG,富集分析结果显示这些基因主要参与细胞死亡调控、细胞程序性死亡、细胞凋亡、免疫过程以及多种信号通路的调节。机器学习筛选出3个核心OSRG:ATF3、JUN、VEGFA,其均在CABG术后上调表达(P<0.01)。并预测5种靶向药物。结论 本研究通过综合运用WGCNA和机器学习方法,成功筛选出CABG术后核心OSRG,这些核心基因术后均明显上调,通过诱导细胞死亡、免疫等方式,引起MIRI。