Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis:a 5-year analysis in an Asian population

BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.

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.

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.

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.

Optimizing care for ST-elevation myocardial infarction patients： application of systems engineering

Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality.

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.

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

Background Acute myocardial infarction （AMI） is the most serious type of coronary heart disease. However, less than 30% of these patients have been treated effectively in China. Delayed treatment is a leading cause. This study aimed to evaluate a new regional cooperative model for improving the first medical contact-to-device time and the therapeutic effects on AMI patients. Methods A retrospective analysis of 458 ST-elevation myocardial infarction （STEMI） patients was performed. Patients were divided into two groups in terms of before or after the model were implemented. First medical contact-to-device time （FMC2D）, Door to device time （D2D）, referral time, cardiac functions, mean cost, days of hospitalization, and major adverse cardiac events （MACE） were analyzed. Results The mean FMC2D time, D2D time and referral time of the model group were significantly lower than the control group. The left ventricular ejection fraction of the model group increased but the left ventricular end-diastolic dimension decreased compared with the control group at 6 months after discharge. These re- sults also showed that mean costs and days of hospitalization were reduced. The MACE rate was reduced in the model group. Conclusions These results suggested that the new model decreased the FMC2D time, which could improve the cardiac function and therapeutic effect of STEMI patients as well as decreased the financial burden.

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

Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service （EMS） STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties （Nassau, Camden and Charlton Counties） within a 50-mile radius of University of Florida Health-Jacksonville （UFHJ） from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements： （1） a cooperative agreement between each of the rural emergency medical service （EMS） agency and UFHJ; （2） performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and （3） direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device （FMC2D）, door-to-device （D2D）, and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio （OR） of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs （81 ± 17 vs. 87± 19 min）, but D2D times were similar （37 ± 18 vs. 39 ± 21 min）. FMC2D 〈 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs （OR = 4.4, 95% CI： 1.24-15.57; P = 0.018）. FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D 〈 120 min. Conclusions Guideline-compliant FMC2D ≤90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time 〈 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.

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

Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.

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.

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.

Successful emergency surgical intervention in acute non-STsegment elevation myocardial infarction with rupture:A case report

BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.