Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis

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.

Development of Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy for Patients with ST-Elevation Myocardial Infarction and Assessment of Its Use in Egypt

Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.

Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.

Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management,a nationwide analysis

BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used STATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation(ECMO)(OR:3.10 P<0.05)in the LC group were associated with increased mortality.Early PCI(-2.57 P<0.05)and Impella(-3.25 P<0.05)were also both associated with shorter LOS compared to those who did not.Early ECMO does not impact the LOS;however,it does increase total hospital charge(addition of$24717.85,P<0.05).CONCLUSION LC is associated with a significantly increased inpatient mortality,length of stay,and total hospital charges in patients who develop SRCS.Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges.The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care.Patients with early PCI had both shorter LOS and reduced inpatient mortality,while early Impella was associated with increased mortality and shorter LOS.Early ECMO is associated with increased mortality and higher total hospital charges.This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.

The expression of oxidative stress genes related to myocardial ischemia reperfusion injury in patients with ST-elevation myocardial infarction

BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism.METHODS:The mononuclear cells were separated by ficoll centrifugation,and plasma total antioxidant capacity(T-AOC)was determined by the ferric reducing ability of plasma(FRAP)assay.The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction(qRT-PCR).Additionally,gene ontology(GO)enrichment analysis was performed on DAVID website to analyze the potential mechanism further.RESULTS:The total numbers of white blood cells(WBC)and neutrophils(N)in the peripheral blood of STEMI patients(the AMI group)were significantly higher than those in the control group(WBC:11.67±4.85×10^(9)/L vs.6.41±0.72×10^(9)/L,P<0.05;N:9.27±4.75×10^(9)/L vs.3.89±0.81×10^(9)/L,P<0.05),and WBCs were significantly associated with creatine kinase-myocardial band(CK-MB)on the first day(Y=8.945+0.018X,P<0.05).In addition,the T-AOC was significantly lower in the AMI group comparing to the control group(12.80±1.79 U/mL vs.20.48±2.55 U/mL,P<0.05).According to the gene analysis,eight up-regulated differentially expressed genes(DEGs)included GADD45A,PRDX2,HSPD1,DNAJB1,DNAJB2,RAD50,TNFSF6,and TRADD.Four down-regulated DEGs contained CCNG1,CAT,CYP1A1,and ATM.TNFSF6 and CYP1A1 were detected by polymerase chain reaction(PCR)to verify the expression at different time points,and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression.GO and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response(UPR)and apoptosis.CONCLUSIONS:WBCs,especially neutrophils,were the critical cells that mediating reperfusion injury.MIRI was regulated by various genes,including oxidative metabolic stress,heat shock,DNA damage and repair,and apoptosis-related genes.The underlying pathway may be associated with UPR and apoptosis,which may be the novel therapeutic target.

Global myocardial strain assessment by different imaging modalities to predict outcomes after ST-elevation myocardial infarction:A systematic review

AIM: To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction(STEMI).METHODS: An online literature search was performed in Pub Med and OVID&#174; electronic databases to identify any studies that assessed global myocardial strain parameters using speckle-tracking echocardiography(STE) and/or cardiac magnetic resonance imaging(CMR) techniques [either myocardial tagging or feature tracking(FT) software] in an acute STEMI cohort(days 0-14 post-event) to predict prognosis [either development of major adverse cardiac events(MACE)] or adverse left ventricular(LV) remodelling at follow-up(≥ 6 mo for MACE,≥ 3 mo for remodelling). Search was restricted to studies within the last 20 years. All studies that matched the pre-defined search criteria were reviewed and their results interpreted. Due to considerable heterogeneity between studies,metaanalysis was not performed.RESULTS: A total of seven studies(n = 7) were identified that matched the search criteria. All studies used STE to evaluate strain parameters- five(n = 5) assessed global longitudinal strain(GLS)(n = 5),one assessed GLS rate(GLS-R)(n = 1) and one assessed both(n = 1). Three studies showed that GLS independently predicted the development of adverse LV remodelling by multivariate analysis- odds ratio between 1.19(CI: 1.04-1.37,P < 0.05) and 10(CI: 6.7-14,P < 0.001) depending on the study. Four studies showed that GLS predicted the development of MACE- hazard ratio(HR) between 1.1(CI: 1-1.1,P = 0.006) and 2.34(1.10-4.97,P < 0.05). One paper found that GLS-R could significantly predict MACEHR 18(10-35,P < 0.001)- whilst another showed it did not. GLS <-10.85% had sensitivity/specificity of 89.7%/91% respectively for predicting the development of remodelling whilst GLS <-13% could predict the development of MACE with sensitivity/specificity of 100%/89% respectively. No suitable studies were identified that assessed global strain by CMR tagging or FT techniques.CONCLUSION: GLS measured acutely post-STEMI by STE is a predictor of poor prognosis. Further research is needed to show that this is true for CMR-based techniques.

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital

圣举起心肌的梗塞(STEMI ) 指南由主要经皮的冠的干预(一种总线标准) 推荐灌注从第一医药接触(FMC ) 的时间的 90 min。这策略在缺乏一所附近一种总线标准有能力的医院的农村区域是挑战性的。推荐灌注时间能为在一所附近一种总线标准有能力的医院外面，由医疗服务(他们) STEMI 地 triage protocol.MethodsSixty STEMI 病人直接从三个农村县由他们搬运了的协议驱动的紧急情况的使用由地面交通在农村区域介绍给一所中央一种总线标准有能力的医院的 STEMI 病人被完成(拿骚，卡姆登和 Charlton 县)在佛罗里达的大学的50英里的半径以内，到 12/31/2013 的从 01/01/2009 的 Health-Jacksonville ( UFHJ )是 iden STEMI 地 triage 协议合并了三个元素：(1 ) 在每农村紧急情况之间的一个合作协议医疗服务(他们) 机构和 UFHJ；(2 ) 医院前 ECG 到的性能便于 STEMI 鉴定和实验室激活；并且(3 ) 直接由地面交通转到 UFHJ 心脏的 catheterization 实验室。 FMC-to-device ( FMC2D )， door-to-device ( D2D )，和运输时间，星期的日子，白天的时间，和他们转移时间被记录，并且机会比率(或)完成 FMC2D 时间 calculated.ResultsFMC2D 时间是更短的为安置 STEMI ( 81 牡楤污椠普牡瑣潩????敍桴摯?琠瑯污漠???挠湯敳畣楴敶??瀠瑡敩瑮?摡業瑴摥琠?敐楫杮唠楮敶獲瑩?敐灯敬?潈灳瑩污映潲?慊畮牡???琠?敄散扭牥㈠?‵敷敲爠'填船摀?桔楥?汣湩捩污挠慨慲瑣牥獩楴獣眠牥?敲牴獯数瑣癩汥?潣灭牡摥戠瑥敷湥瀠瑡敩瑮?楷桴漠?楷桴畯??敲畣牲湥???吠敨?畭瑬癩牡慩?

A new cooperative approach for ST-elevation myocardial infarction patients to receive timely and effective percutaneous coronary reperfusion in China

BackgroundAcute 心肌的梗塞(AMI ) 是冠的心疾病的最严肃的类型。然而，不到 30% 这些病人在中国有效地被对待。推迟的治疗是一个领先的原因。这研究试图为在 AMI patients.MethodsA 上改进第一医药 contact-to-device 时间和治疗学的效果评估一个新地区性的合作模型 458 圣举起心肌的梗塞(STEMI ) 的回顾的分析病人们被执行。病人们被划分成二个组以在模型前后被实现。第一医药 contact-to-device 时间( FMC2D )，到设备时间( D2D )的门，工作分派时间，心脏的功能，吝啬的费用，住院的天，和主要不利心脏的事件(向)是 analyzed.ResultsThe 平均数 FMC2D 时间，模型组的 D2D 时间和工作分派时间比控制组显著地低。模型组的左室的喷射部分增加了，但是左室的结束心脏舒张的尺寸在分泌物以后在 6 个月与控制组相比减少了。这些结果也证明住院的吝啬的费用和天被减少。向率在建议的模型 group.ConclusionsThese 结果被减少新模型减少了 FMC2D 预定病人，它能改进心脏的功能和 STEMI 的治疗学的效果象一样减少金融负担。

Thrombosis in ST-elevation myocardial infarction:Insights from thrombi retrieved by aspiration thrombectomy

In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.

Effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention

Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total of 200 patients(60.1 ± 11.3 years) with STEMI who underwent successful PPCI from January 2010 to December 2013 were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions. Patients were divided into two groups according to the dosage of ramipril used at hospital discharge as follows: high dosage group(2.5–10 mg, q.d.) and low dosage group(1.25–2.5 mg, q.d.). Clinical and angiographic follow-up was performed for 12 months. The primary endpoint was clinically-driven percutaneous coronary intervention(PCI) for nonculprit lesions. The clinical and angiographic features were analyzed. Results Clinical and angiographic follow-up was performed with 87 patients in the high dosage group and 113 patients in the low dosage group. The numbers of patients who underwent additional PCI were six and 20 in the high and low dosage groups, respectively. The rate of having additional PCI performed was lower in the high dosage group than in the low dosage group(6.90% vs. 17.70%, P = 0.03). Conclusions A high dosage of ramipril may prevent progression of nonculprit lesions, which could be the major cause of recurrent PCI in patients with STEMI after PPCI.

Total ischemic time and outcomes for patients with ST-elevation myocardial infarction： does time of admission make a difference？

ObjectiveTo 调查录取时间是否与圣举起心肌的梗塞(STEMI ) 在病人与灌注治疗和在里面医院死亡的延期被联系进入紧急情况部门并且在在 2012 年 4 月和 2015 年 3 月之间的北京大学民族医院经历了主要经皮的冠的干预的有 STEMI 的 .MethodsAll 病人被包括。我们在在病人之间的死亡在在常规小时期间承认的不值勤的时间或时期和那些期间承认了的临床的特征，全部的 ischemic 时间，和在里面医院检验了差别。Multivariate 逻辑回归被用来估计在不值勤的时间或时期录取和临床的 outcome.ResultsThe 样品之间的关系包括了 184 和 105 个病人， STEMI 分别地在不值勤的时间或时期和常规小时期间承认了到医院。全部的 ischemic 和 onset-to-door 时间在比在在常规小时期间承认的那些之中在不值勤的时间或时期期间招收的病人是显著地更短的(所有 P &#x0003c；0.05 ) 。Door-to-balloon (DTB ) 时间， DTB 时间 &#x02264 的率；90 min，和在里面医院死亡在组之间是可比较的。Multivariate 逻辑回归显示出那年龄和 creatinine 水平，然而并非不值勤的时间或时期承认，与增加的在里面医院 death.ConclusionsOff 小时承认独立地被联系没导致推迟的灌注在有 STEMI 的病人的治疗或增加的在里面医院死亡。进一步的努力应该集中于识别与医院前和灌注治疗的在里面医院延期联系的枢轴的因素，并且为灌注节目实现优秀改进行动。

E/e’ as a Predictor of Short-Term Survival Following ST-Elevation Myocardial Infarction

Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years;80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of 15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings.

Relationship between serum CRP level and left ventricular function in patients with acute ST-elevation myocardial infarction: A cross-sectional study

Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients' records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9%(82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6%(44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.

Variations in non-ST-elevation myocardial infarction care across three levels of hospitals in China:analysis from the China Acute Myocardial Infarction Registry

Objective To explore the variation of treatment and outcomes for NSTEMI across different-level hospitals, which potentially influenced by unbalanced economy and disparate medical care.Methods The China AMI registry consists of 108 hospitals across three levels (province, prefecture and county) throughout China.

Correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction

Objective:To analyze the correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Methods:80 patients with acute ST-elevation myocardial infarction were divided into high iron group (serum iron≥8.95μmol/L) (n=43) and low iron group (serum iron<8.95μmol/L) (n=37) according to serum iron levels, differences in myocardial injury markers, ventricular remodeling indexes and pump failure-related indexes on admission were compared between two groups of patients, and the correlation of serum iron levels with myocardial damage and pump failure in patients with acute ST-elevation myocardial infarction was further analyzed. Results:Serum myocardial injury markers troponin I (cTnI), creatine kinase isoenzyme (CK-MB), myoglobin (Myo), ischemia modified albumin (IMA) and hydroxybutyrate dehydrogenase (HBDH) content of high iron group on admission were significantly lower than those of low iron group (P<0.05);left ventricular posterior wall thickness (LVPWT), left ventricular end-systolic interventricular septal thickness (IVST), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), end-systolic volume index (ESVI), end-diastolic volume index (EDVI), and the left ventricular mass index (LVMI) levels under color Doppler ultrasound were lower than those of low iron group (P<0.05);serum N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, adiponectin (APN), soluble P-selectin (sP-selectin) and Copeptin content were lower than those of low iron group (P<0.05). Pearson test showed that serum iron level was directly correlated with the degree of myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Conclusions:Low serum iron levels is one of key factors causing severe cases and pump failure in STEMI patients, and early iron supplementation is expected to improve outcomes in STEMI patients with iron deficiency.

Chinese Expert Consensus on Microvascular Protection Strategy During Emergency Percutaneous Coronary Intervention Therapy in Patients With ST-elevation Myocardial Infarction

Microcirculatory dysfunction(CMD)typically occurs in patients with acute ST-segment elevation myocardial infarction during percutaneous coronary intervention,which is associated with more severe myocardial injury and a worse prognosis.With the advancement of intracoronary physiology and imaging technology,the prevention and therapeutic interventions of CMD have attracted more attention.However,relevant guidelines or consensus on CMD are lacking in China.The current consensus summarizes the prevention and diagnostic strategies of emergency percutaneous coronary intervention-related CMD and gives suggestions to improve the prognosis of ST-segment elevation myocardial infarction patients based on evidence from recent clinical studies,guidelines,and consensus from international sources.

Use of Beta-Blocker in Acute ST-Elevation Myocardial Infarction

This paper reported beta-blocker use in 21 STEMI patients over four years. The patients were between 50 - 65 years of age presenting with anterior, lateral, and inferior STEMI (ST-Elevation Myocardial Infarction). Seven of the patients were female, and 14 were male. They presented to an emergency room of a rural hospital that did not provide emergency percutaneous coronary angioplasty/stenting (PTCA/stenting). The hospital is about 70 minutes from a facility that provided PTCA/ stenting—all the patients presented with typical angina chest pain with ST elevation. They are hemodynamic stable. Most patients received Lopressor 35 mg IVP, with one receiving 115 mg in a 5 mg increment. They were chest pain-free and hemodynamically before leaving the ER for the transfer for PTCA/stent. The results demonstrated that beta-blockers are effective in relieving pain in STEMI patients. Further study is needed to determine its efficacy, safety, and how to use it.

The role of neutrophil to platelet ratio in predicting death in elderly patients with ST-elevation myocardial infarction receiving percutaneous coronary intervention

Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with STEMI were included and divided into three groups according to the tertiles of NPR:<37(n=253),37-54(n=257),and≥54(n=257).Multivariate logistic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,P<0.001].The receiver operating characteristic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P<0.001,sensitivity=77.1%,specificity=69.0%,optimal cut-off value=54).As for 1-year mortality,multivariate Cox survival analysis revealed that NPR[hazard ratio(HR)=1.003,95%CI:1.001-1.004,P<0.001],as a continuous variable,and NPR>54(HR=2.70,95%CI 1.72-4.22,P<0.001),as a categorial variable,were both independent predictors for 1-year mortality.Conclusions NPR is a feasible predictor of poor prognosis for elderly patients with STEMI receiving PCI.

Polar residual network model for assisting evaluation on rat myocardial infarction segment in myocardial contrast echocardiography

Objective To investigate the value of polar residual network(PResNet)model for assisting evaluation on rat myocardial infarction(MI)segment in myocardial contrast echocardiography(MCE).Methods Twenty-five male SD rats were randomly divided into MI group(n=15)and sham operation group(n=10).MI models were established in MI group through ligation of the left anterior descending coronary artery using atraumatic suture,while no intervention was given to those in sham operation group after thoracotomy.MCE images of both basal and papillary muscle levels on the short axis section of left ventricles were acquired after 1 week,which were assessed independently by 2 junior and 2 senior ultrasound physicians.The evaluating efficacy of MI segment,the mean interpretation time and the consistency were compared whether under the assistance of PResNet model or not.Results No significant difference of efficacy of evaluation on MI segment was found for senior physicians with or without assistance of PResNet model(both P>0.05).Under the assistance of PResNet model,the efficacy of junior physicians for diagnosing MI segment was significantly improved compared with that without the assistance of PResNet model(both P<0.01),and was comparable to that of senior physicians.Under the assistance of PResNet model,the mean interpretation time of each physician was significantly shorter than that without assistance(all P<0.001),and the consistency between junior physicians and among junior and senior physicians were both moderate(Kappa=0.692,0.542),which became better under the assistance(Kappa=0.763,0.749).Conclusion PResNet could improve the efficacy of junior physicians for evaluation on rat MI segment in MCE images,shorten interpretation time with different aptitudes,also improve the consistency to some extent.