Electrocardiographic predictors of cardiovascular events in patients at high cardiovascular risk: a multicenter study

Background There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. Methods Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. Results A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS)(21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD)(7.3%), left ventricular hypertrophy (LVH)(12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. Conclusions A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.

Arterial hypertension and electrocardiographic diagnosis of left ventricular hypertension in the group of geriatric patients with coronary heart disease living in the far north

As a result of research, high prevalence of arterial hypertension has been identified in the group of patients with coronary heart disease aged 60 and older. Most often, occurring form of arterial hypertension among geriatric patients is isolated systolic arterial hypertension (ISAH). The comparison of two ethnic groups of the population has showed higher levels of systolic and diastolic blood pressure (SBP and DBP) in the group of patients of non-indigenous nationality, rather than Yakut patients. Correlation was recorded in the group of non-indigenous patients as they age. Significant increase in the level of SBP was identified in the group of senile and long-livers than in the elderly. Detection of ECG signs of LVH showed the lowest specificity of Cornell voltage criterion comparing to Sokolow-Lyon criterion with its more often occurrence. ECG-signs of left ventricle hypertrophy are significantly more often established by Sokolow-Lyon criterion for men, Cornell voltage—for women. Correlation has been found between the presence of LVH and combination of Cornell voltage criterion with both Gubner-Ungerleider and Sokolow-Lyon criteria.

Validity of electrocardiographic criteria for increased left ventricular mass in young patients in the general population

AIMTo investigate validity of electrocardiographic(ECG)criteria for left ventricular hypertrophy(LVH)in young adults.METHODS Retrospectively,echocardiograms showing LVH and concomitant electrocardiograms were collected in patients 18 to 39 years old.A control group of patients without LVH was collected.Using echocardiogram as the gold standard,electrocardiograms were analyzed using common voltage criteria.RESULTS Study included 100 subjects(52%male,mean age=28±6.8 years,96%Hispanic or African-American)with 50%LVH prevalence.Sensitivity and specificity for SokolowLyon criteria were 24%(95%CI:13.5%-38.4%)and 88%(95%CI:74.9%-95%).For Cornell criteria,sensitivity was 32%(95%CI:19.9%-46.8%)and specificity 98%(95%CI:87.9%-99.8%).For R in a VL criteria,sensitivity was 12%(95%CI:4.9%-25%)and specificity 100%(95%CI:91.1%-100%).CONCLUSION In young adults common ECG voltage criteria have low sensitivities and high specificities similar to other age groups.Low sensitivities preclude these ECG criteria from serving as effective screening tests.

Electrocardiographic Safety of Daily Hydroxychloroquine 400 mg Plus Azithromycin 250 mg as an Ambulatory Treatment for COVID-19 Patients in Cameroon

Objective: To determine the early electrocardiographic changes in a cohort of ambulatory cameroonian COVID-19 patients treated with hydroxychlo- roquine and Azithromycin. Design: Prospective study. Setting: Treatment centres of the city of Yaounde, Cameroon, from May 7th to 24th 2020. Participants: We enrolled 51 consecutive confirmed COVID-19 on RT-PCR who having mild forms of COVID-19 and treated by hydroxychloroquine 200 mg twice daily during seven #days plus Azithromycin 500 mg the first day and 250 mg the remaining 4 days as per national standard. Main Outcomes Measures: The primary end-point was the change in QTc interval between day 0 (D0), day 3 (D3) and day 7 (D7). Secondary endpoints were changes in all other cardiac electrical conductivity patterns and the occurrence of clinical arrhythmic events during the course of treatment. Results: The population (29 men and 22 women) was aged 39 ± 11 years (range 17 to 61 years). Mean Tisdale score was 3.35 ± 0.48. No significant change from baseline (D0) of QTc was observed at D7 (429 ± 27 ms at D0 versus 396 ± 26 ms at D7;p = 0.27). A reduction of heart rate was observed between the D0 and D7 (75 ± 13 bpm versus 70 ± 13 bpm, p = 0.02) with increased QRS duration between D0 and D7 (95 ± 10 ms versus 102 ± 17 ms, p = 0.004). No symptomatic arrhythmic events occurred during the treatment course. Conclusions: No life-threatening modification of the QT interval was observed in non-severe COVID-19 patients treated ambulatory with hydroxychloroquine and azithromycin. Studies are needed in critical-ill and older patients.

Electrocardiographic Manifestations of Endocrine and Metabolic Disorders

Endocrine dysfunction has an adverse impact on the cardiovascular system that may be due to an endocrine abnormality that leads to electrocardiogram (EKG) changes. The EKG changes due to endocrine disorder can be reversible and irreversible and treating underlying disease can reverse EKG changes in some cases. In this article, we review the electrocardiogram manifestations of various endocrine disorders.

Comparative Study of Acute Coronary Syndrome with Persistent ST-Segment Elevation (STEMI) between Diabetics and Non-Diabetics in Dakar, Senegal

Introduction: This study aimed to compare the frequency of diabetic and non-diabetic patients admitted for ST-elevation myocardial infarction (STEMI), assess their epidemiological, clinical, and paraclinical profiles, and evaluate their therapeutic strategies and outcomes. Methodology: A descriptive, analytical, comparative study with prospective and retrospective data collection was conducted from April 1, 2020, to March 31, 2021. Diabetic and non-diabetic patients with STEMI admitted to a cardiology department were included. STEMI diagnosis was based on clinical and electrocardiographic criteria showing persistent ST-segment elevation in at least two leads. All patients included in the study signed a written, informed consent form. Data analysis was performed using SPSS, with a p-value ≤ 0.05 considered statistically significant. Results: STEMI prevalence was 15.27%, with 37.11% of patients being diabetic and 62.89% non-diabetic. Diabetic patients had a mean age of 59.2 ± 10.9 years, while non-diabetics averaged 58 ± 13.4 years. Diabetics were predominantly female (72.2%), whereas non-diabetics were mainly male (83.6%). Smoking was less frequent among diabetics (25% vs. 47.54%), but hypertension, obesity, and sedentary lifestyle were more common. Diabetics had an average of 3.5 ± 1.1 risk factors compared to 2.6 ± 1.2 in non-diabetics. Admission delay was longer for diabetics (34.8 ± 51.6 hours vs. 23.3 ± 52.3 hours). Chest pain was the main symptom in both groups. Electrocardiograms showed that anterior and inferior infarctions were most frequent. Triple vessel disease and severe complications, such as cardiogenic shock, were more common in diabetics, who also had higher mortality (5.56% vs. 3.28%). Conclusion: Diabetic STEMI patients represent a high-risk group with distinct clinical features, longer admission delays, and a greater accumulation of cardiovascular risk factors, emphasizing the need for targeted interventions.

Comprehensive analysis of the impact of primary percutaneous coronary intervention on patients with ST-segment elevation myocardial infarction

This comprehensive analysis by Saeed and Faeq investigates the impact of primary percutaneous coronary intervention(pPCI)on mortality among patients with ST-segment elevation myocardial infarction(STEMI)at the Erbil Cardiac Center.Analyzing data from 96 consecutive STEMI patients,the study identified significant predictors of in-hospital mortality,emphasizing the critical impact of time of hospital arrival post-symptom onset on overall prognosis.Findings indicate that factors such as atypical presentation,cardiogenic shock,chronic kidney disease,and specific coronary complications are associated with higher mortality rates.The study underscores the necessity of prompt medical intervention for improving survival outcomes in STEMI patients,especially in the high-risk subgroup.This research offers valuable insights into optimizing STEMI management and enhancing patient survival rates through effective and timely pPCI.

A Comparative Study of Risk Factors and Prognosis in Young and Elderly Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective:To investigate the differences in risk factors and prognosis between young and elderly patients with acute ST-segment elevation myocardial infarction(STEMI)so as to provide a basis for the prevention of young patients with acute STEMI.Methods:Patients initially diagnosed with STEMI in the 920"Hospital of Joint Logistic Support Force of PLA from January 1,2018 to December 31,2022 were retrospectively enrolled in this study.A total of 235 STEMI patients aged≤45 years old and 532 STEMI patients aged≥65 years old were screened.The baseline characteristics,laboratory indicators,clinical characteristics,coronary angiography,SYNTAX score and major adverse cardiovascular events(MACE)during 1-year follow-up were analyzed and compared.Results:A total of 767 STEMI patients were enrolled,including 235 in the young group and 532 in the elderly group.Among the STEM patients in the young group,224 cases were male,and smoking and drinking were common.Compared with the elderly group,the young group had shorter hospital stays and more family history of ischemic heart disease(IHD).The level of low-density lipoprotein in the young group was higher than that in the old group,while the level of high-density lipoprotein in the young group was lower than that in the old group.The level of high uric acid and homocysteine in the young group was significantly higher than that in the old group.The main cause of STEMI in the young group was fatigue,and the most common symptom was angina pectoris.Coronary angiography showed that single vessel disease was more common in the young group than in the elderly group,and the lesion in the young group was the left anterior descending artery.The SYNTAX score was significantly lower in the young group than in the elderly group according to the anatomical characteristics of coronary artery disease.In the forest plot,diabetes mellitus and a family history of IHD showed a trend of major adverse cardiovascular events(MACE)in both groups.Conclusion:Males,smokers,alcohol drinkers and family history of ischemic heart disease are more common in young patients.Common risk factors include fatigue,hyperuricemia,hyperlipidemia and so on.In addition,age itself is an independent risk factor.Management of diabetes,hyperuricemia,and homocysteine levels is essential to reduce the incidence of cardiovascular events in young patients.By controlling these factors,the incidence of young patients with acute STEMI can be effectively prevented and the corresponding prevention and treatment basis can be provided.

一种关于ST-SEGMENT定位的综合算法

给出了一种针对ST段T波起点精确定位的新方法——三角形法;作者在分析各种方法的基础上,总结了一个ST-SEGMENT综合算法,用该算法对仿真数据进行测试结果表明其运行速度快,定位精度高;并且算法简便。

De Winter syndrome and ST-segment elevation myocardial infarction can evolve into one another: Report of two cases

BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed STsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.

Culprit vessel only versus ＂one-week＂ staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction

Objective To explore the impact of a ＂one-week＂ staged muhivessel percutaneous coronary intervention （PCI） versus culprit-only PCI on deaths and major adverse cardiac events （MACE）. Methods We retrospectively analyzed 447 patients with multivessel disease who experienced a ST-segment elevation myocardial infarction （STEMI） within 12 h before undergoing PCI between July 26, 2008 and Septem- ber 25, 201 l. After completion of PCI in the infarct artery, 201 patients still in the hospital agreed to undergo PCI in non-infarct arteries with more than 70% stenosis for a ＂one-week＂ staged multivessel PCI. A total of 246 patients only received intervention for the culprit vessel. Follow-up ended on September 9, 2014. This study examined the differences in deaths from any cause （i.e., cardiac and noncardiac） and MACE between the two treatment groups. Results Compared to a culprit-only PCI treatment approach, the ＂one-week＂ staged multivessel PCI was strongly associated with greater benefits for 55-month all cause death [41 （16.7%） vs. 13 （6.5%）, P = 0.004] and MACE [82 （33.3%） vs. 40 （19.9%）, P = 0.002] rates. In addition, there were significant differences in the number of myocardial infarctions [43 （17.5%） vs. 20 （10.0%）, P = 0.023], coronary-artery bypass grafting [CABG; 20 （8.1%） vs. 6 （3.0%）, P = 0.021], and PCI [31 （12.6%） vs. 12 （6.0%）, P - 0.018]. Patients undergoing culprit-only PCI compared to ＂one-week＂ PCI had the same number of stent thrombosis events [7 （2.8%） vs. 3 （1.5%）, P - 0.522]. Conclusions Compared to a culprit-only PCI treatment approach, ＂one-week＂ staged multi-vessel PCI was a safe and effective selection for STEMI and multi-vessel PCL

Stenting versus non-stenting treatment of intermediate stenosis culprit lesion in acute ST-segment elevation myocardial infarction： a multicenter random- ized clinical trial

Background The benefit/risk ratio of stenting in acute ST-segment elevation myocardial infarction （STEMI） patients with single vessel intermediate stenosis culprit lesions merits further study, therefore the subject of the present study. Methods and results It was a pro- spective, multicenter, randomized controlled trial. Between April 2012 and July 2015, 399 acute STEMI patients with single vessel disease and intermediate （40%-70%） stenosis of the culprit lesion before or after aspiration thrombectomy and/or intracoronary tirofiban （15 pg/kg） were enrolled and were randomly assigned （h 1） to stenting group （n = 201） and non-stenting group （n = 198）. In stenting group, patients received pharmacologic therapy plus standard percutaneous coronary intervention （PCI） with stent implantation. In non-stenting group, pa- tients received pharmacologic therapy and PCI （thrombectomy）, but without dilatation or stenting. Primary endpoint was 12-month rate of major adverse cardiac and eerebrovascular events （MACCE）, a composite of cardiac death, non-fatal myocardial infarction （M1）, repeat re- vascularization and stroke. Secondary endpoints were 12-month rates of all cause death, ischemia driven admission and bleeding complica- tion. Median follow-up time was 12.4 ~ 3.1 months. At 12 months, MACCE occurred in 8.0% of the patients in stenting group, as compared with 15.2% in the non-stenting group （adjusted HR： 0.42, 95% Ch 0.19-0.89, P = 0.02）. The stenting group had lower non-fatal MI rate than non-stenting group, （1.5% vs. 5.5%, P = 0.03）. The two groups shared similar cardiac death, repeat revascularization, stroke, all cause death, ischemia driven readmission and bleeding rates at 12 months. Conclusions Stent implantation had better efficacy and safety in reducing MACCE risks among acute STEMI patients with single vessel intermediate stenosis culprit lesions.

Post-dilatation improves stent apposition in patients with ST-segment elevation myocardial infarction receiving primary percutaneous intervention: A multicenter, randomized controlled trial using optical coherence tomography

BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).

The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction： results from the Korean Acute Myocardial Infarction National Registry with Registries

Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction （STEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.

Additional manual thrombus aspiration for ST-segment elevation myocardial infarction during percutaneous coronary intervention： an updated meta- analysis

Background The clinical efficacy and safety of adjunctive thrombus aspiration （TA） in patients with ST-segment elevation myocardial infarction （STEMI） during percutaneous coronary intervention （PCI） remain controversial. Methods Twenty five eligible randomized controlled trials were included to compare the use of thrombus aspiration （TA） with PCI and PCI-only for STEMI. The primary endpoint was all-cause mortality and death. The secondary endpoints were major adverse cardiac events （MACE）, recurrent infarction （RI）, target vessel revascularization （TVR）, stent thrombosis （ST）, perfusion surrogate markers and stroke. Results TIMI flow grade 3 and MBG 2-3 were significantly increased in the TA plus PCI arm compared with the PCI-only arm [relative risk （RR）： 1.05, 95% confidence intervals （CI）： 1.02-1.09, P = 0.004] and （RR： 1.68, 95% CI： 1.40-2.00, P 〈 0.001）, respectively. There were no significant differences in all-cause mortal- ity, MACEs, TVR and ST rates between the two groups. The RI rate was lower in the TA plus PCI arm than that in the PCI-only arm with short-term follow-up duration （RR： 0.60, 95% CI： 0.38-0.96, P = 0.03）, but there was no significant difference in RI incidence over the me- diumor long-term follow-up periods （RR： 1.00, 95% CI： 0.77-1.29, P = 0.98）, and （RR： 0.96, 95% CI： 0.81-1.15, P = 0.69）, respectively. There were statistically significant differences in the rates of crude stroke and stroke over the medium- or long-term follow-up periods and the crude stroke rate in the TA plus PCI （RR： 1.60, 95% CI： 1.08-2.38, P = 0.02） and （RR： 1.43, 95% CI： 1.03-1.98, P = 0.03）, respectively; this was not observed between the two arms during the short-term follow-up period （RR： 1.47, 95% CI： 0.97-2.21, P = 0.07）. Conclusions Routine TA-assisted PCI in STEMI patients can improve myocardial reperfusion and get limited benefits related to the clinical endpoints, which may be associated with stroke risk.

Long-term outcomes of staged recanalization for concurrent chronic total occlusion in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.

Effects of nicorandil on myocardial infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention:study design and protocol for the randomized controlled trial

Previous studies have shown that nicorandil has a protective effect on cardiomyocytes.However,there is no study to investigate whether perioperative intravenous nicorandil can further reduce the myocardial infarct size in patients with ST-segment elevation myocardial infarction(STEMI)compared to the current standard of percutaneous coronary intervention(PCI)regimen.The CHANGE(China-Administration of Nicorandil Group)study is a multicenter,prospective,randomized,double-blind and parallel-controlled clinical study of STEMI patients undergoing primary PCI in China,aiming to evaluate the efficacy and safety of intravenous nicorandil in ameliorating the myocardial infarct size in STEMI patients undergoing primary PCI and provide evidence-based support for myocardial protection strategies of STEMI patients.

Does manual thrombus aspiration help optimize stent implantation in ST-segment elevation myocardial infarction?

AIM: To evaluate the impact of thrombus aspiration(TA) on procedural outcomes in a real-world ST-segment elevation myocardial infarction(STEMI) registry.METHODS: From May 2006 to August 2008, 542 consecutive STEMI patients referred for primary or rescue percutaneous coronary intervention were enrolled and the angiographic results and stent implantation characteristics were compared according to the performance of manual TA.RESULTS: A total of 456 patients were analyzable and categorized in TA group(156 patients; 34.2%) and non-TA(NTA) group(300 patients; 65.8%). Patientstreated with TA had less prevalence of multivessel disease(39.7% vs 54.7%, P = 0.003) and higher prevalence of initial thrombolysis in myocardial infarction flow 【 3(P 【 0.001) than NTA group. There was a higher rate of direct stenting(58.7% vs 45.5%, P = 0.009), with shorter(24.1 ± 11.8 mm vs 26.9 ± 15.7 mm, P = 0.038) and larger stents(3.17 ± 0.43 mm vs 2.93 ± 0.44 mm, P 【 0.001) in the TA group as compared to NTA group. The number of implanted stents(1.3 ± 0.67 vs 1.5 ± 0.84, P = 0.009) was also lower in TA group. CONCLUSION: In an “all-comers” STEMI population, the use of TA resulted in more efficient procedure leading to the implantation of less number of stents per lesion of shorter lengths and larger sizes.

N-terminal pro-B-type natriuretic peptide as prognostic marker for patients of non ST-segment elevation myocardial infarction

In this work, we analyzed only the patients of the NSTEMI (non ST-segment elevation myocardial infarction) who arrived at the hospital within 12 h after symptoms started. Using NSTEMI follow-up data within, the characteristics of the clinical data, the risk factor, and the blood tested in the hospital visit were analyzed for MACE (major adverse cardiac events) patients. MACE includes cardiac death, MI (myocardial infarction), Re-PCI, and CABG (coronary artery bypass graft). As a result, from the NSTEMI patients which can be followed up for over 12 m, NT-ProBNP (p=0.014) and age (p=0.045) are found to be the independent risk factors related to MACE. Accordingly, they can be useful for the diagnosis and prognosis for NSTEMI patients as a biomarker.

WeChat Group of Chest Pain Center for Patients with Acute ST-segment Elevation Myocardial Infarction:Faster Treatment Speed and Better Prognosis

Objective:To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods:The chest pain center,established by the creation of a WeChat group,included primary hospitals in Chongqing that are not able to perform PPCI and the First Affi liated Hospital of Chongqing Medical University,which is the core of the center and which includes medical staff of the catheter laboratory,the cardiology department,the emergency,the vascular surgery department,and the cardiothoracic surgery department.Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled.The patients(including emergency department visitors,120 callers,and patients transferred from the critical care unit or other departments)were divided into a WeChat pre-admission startup group(n=311)and a non-WeChat pre-admission startup group(control group,n=172).Patients’door-to-balloon time,standard door-toballoon time achievement rate,artery puncture to balloon dilation time,heart failure rate,length of stay,and incidence of adverse events(including fatal arrhythmia,cardiogenic shock,and death)during hospitalization were compared between the two groups.Results:Four hundred eight-three consecutive patients were enrolled.There was no signifi cant difference in patients’sex,age,length of stay,and cardiovascular events during hospitalization between the two groups(P>0.05).The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group(27.35±10.58 min vs.88.15±53.79 min,P<0.05).The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group(100%vs.72.09%,P<0.05).Conclusion:The application of a WeChat platform signifi cantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI.In addition,the platform is also conducive to integrating medical resources and sharing medical information.The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI.