Clinical and procedural predictors of no-ref low in patients with acute myocardial infarction after primary percutaneous coronary intervention

BACKGROUND: The treatment of acute myocardial infarction(AMI) is thought to restore antegrade blood flow in the infarct-related artery(IRA) and minimize ischemic damage to the myocardium as soon as possible. The present study aimed to identify possible clinical predictors for no-refl ow in patients with AMI after primary percutaneous coronary intervention(PCI).METHODS: A total of 312 consecutive patients with AMI who had been treated from January 2008 to December 2010 at the Cardiology Department of East Hospital, Tongji University School of Medicine were enrolled in this study. Inclusion criteria were:(i) patients underwent successfully primary PCI within 12 hours after the appearance of symptoms; or(ii) patients with ischemic chest pain for more than 12 hours after a successful primary PCI within 24 hours after appearance of symptoms. Exculsion criteria were:(i) coronary artery spasm;(ii) diameter stenosis of the culprit lesion was ≤50% and coronary blood f low was normal;(iii) patients with severe left main coronary or multivessel disease, who had to require emergency revascularization. According to thrombolysis in myocardial infarction(TIMI), the patients were divided into a reflow group and a no-reflow group. The clinical data, angiography f indings and surgical data were compared between the two groups. Univariate and multivariate logistic regressions were used to determine the predictors for no-ref low.RESULTS: Fifty-four(17.3%) of the patients developed NR phenomenon after primary PCI. Univariate analysis showed that age, time from onset to reperfusion, systolic blood pressure(SBP) on admission, Killip class of myocardial infarction, intra-aortic balloon pump(IABP) use before primary PCI, TIMI flow grade before primary PCI, type of occlusion, thrombus burden on baseline angiography, target lesion length, reference luminal diameter and method of reperfusion were correlated with no-reflow(P<0.05 for all). Multiple logistic regression analysis identified that age >65 years [OR=1.470, 95% confi dence interval(CI) 1.460–1.490, P=0.007], long time from onset to reperfusion >6 hours(OR=1.270, 95%CI 1.160–1.400, P=0.001), low SBP on admission <100 mmHg(OR=1.910, 95%CI 1.018–3.896, P=0.004), IABP use before PCI(OR= 1.949, 95%CI 1.168–3.253, P=0.011), low(≤1) TIMI fl ow grade before primary PCI(OR=1.100, 95%CI 1.080–1.250, P<0.001), high thrombus burden(OR=1.600, 95%CI 1.470–2.760, P=0.030), and long target lesion(OR=1.948, 95%CI 1.908–1.990, P=0.019) on angiography were independent predictors of no-refl ow.CONCLUSION: The occurrence of no-refl ow after primary PCI for acute myocardial infarction can predict clinical, angiographic and procedural features.

General awareness of symptoms of myocardial infarction and the need for urgent treatment:A cross-sectional,street survey in Chennai,Tamil Nadu

Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive research design and convenience sampling.A sample of 800 subjects,using self-structured knowledge questionnaires,was selected for data collection and analysis.The study was conducted at Dr.M.G.R.Educational and Research Institute,India,from February to November 2022.Awareness of myocardial infarction symptoms and intervention timeline(the golden time)was investigated.A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.Results:A total of 800 subjects were included.Among the subjects,367(45.8%)were male,433(54.2%)were female,and 443(55.3%)participants failed to recognize the golden time.Our multivariate logistic regression analysis showed that people with a bachelor’s degree(OR=0.41,95%CI:0.23-0.74,P=0.03)and a high school level diploma(OR=0.55,95%CI:0.31-0.97,P=0.03)are more likely to know about myocardial infarction(golden time)than illiterate people.Additionally,people who are employed(OR=0.59,95%CI:0.41-0.85,P=0.05)are more likely to know about myocardial infarction(golden time)than those who are not.Conclusions:The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action.The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention,which can lead to an increase in mortality and morbidity.

The impact of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction(STEMI)patients after emergency percutaneous coronary intervention(PCI).Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group(standard group,n=60),and 40 mg of atorvastatin treatment group(intensive group,n=60).

Effect of distal protection device on prognosis of acute myocardial infarction combined with emergency percutaneous coronary intervention

The no-reflow and slow blood flow in the process of PCI treatment may reduce its effectiveness and lead to expansion of infarct in size sometimes. Also the application of thrombolytic agent inside of coronary artery,platelet inhibitors GP Ⅱ/Ⅲ or direct thrombectomy can＇t improve short or long-term clinical outcomes, So we evaluated the safety and efficacy of distal protection device （GuardWire PlusTM） in the acute myocardial in farction （AMI） combined with percutaneous coronary intervention （PCI）. Method Seventy-two patients with acute myocardial infarction receiving emergency PCI were randomly assigned into the distal protection group （GW group） and non-distal protection group（NGW） group. Data analyzed between the two groups were included the clinical characteristics, angiographic results, ST segment resolution, postoperative TIMI flow grade, TIMI frame count, myocardial blush grade, the left ventricular ejection fraction （LVEF） by eehocardiography in a Week after or 3 months after PCI, myocardial enzymes,preoperative and postoperative neuroendoerine biomarkers： endothelin （ET）, plasma renin activity （PRA）, angiotensin Ⅱ （AII）, aldosterone（ALD）, norepinephrine（NE）, epinephrine （E）. Results ST segment resolution ≥ 50% was significantly higher in the GW group （68.4%） than in NGW group （41.2%, P 〈 0.05）. Early peak CK-MB and CTNI in GW group versus NGW group （8.63 ±2.42 hours vs 11.18 ±2.26 hours,10.16 ±2.96 hours vs 12.35 ±2.06 hours）, and peak reduction difference were observed （63.3 ±9.82 vs 74.28 ＋ 6.15 P = 0.000, 18.01 ＋ 7.21 vs 21.48 ±5.61 P = 0.027）. Left ventricular ejection fraction （LVEF） was higher in GW group （P = 0.01） than in NGW group. TIMI grade exhibited no difference while TIMI frame count （P = 0.043） and myocardial blush grade were significantly different （P = 0.0001）. Postoperative biomarkers in endocrine expression were higher significantly in NGR group （P 〈 0.05）. Conclusions Emergency PCI combined with distal protection device can help prevent distal embolism, reduce the risk of no-reflow and slow flow and thereafter improve the prognosis in AMI patients.

Intracoronary pressure gradient measurement in acute myocardial infarction patients with the no-reflow phenomenon during primary percutaneous coronary intervention

Background:Various experimental and clinical studies have reported on coronary microcirculatory dysfunction("no-reflow"phenomenon).Nevertheless,pathogenesis and effective treatment are yet to be fully elucidated.This study aimed to measure the intracoronary pressure gradient in the no-reflow artery during emergent percutaneous coronary intervention and explore the potential mechanism of no-reflow.Methods:From September 1st,2018 to June 30th,2019,intracoronary pressure in acute myocardial infarction patient was continuously measured by aspiration catheter from distal to proximal segment in the Department of Coronary Care Unit,Tianjin Chest Hospital,respectively in no-reflow arteries(no-reflow group)and arteries with thrombolysis in myocardial infarction-3 flow(control group).At least 12 cardiac cycles were consecutively recorded when the catheter was pulled back.The forward systolic pressure gradient was calculated as proximal systolic pressure minus distal systolic pressure.Comparison between groups was made using the Student t test,Mann-Whitney U-test or Chi-square test,as appropriate.Results:Intracoronary pressure in 33 no-reflow group and 26 in control group were measured.The intracoronary forward systolic pressure gradient was-1.3(-4.8,0.7)and 3.8(0.8,8.8)mmHg in no-reflow group and control group(Z=-3.989,P<0.001),respectively,while the forward diastolic pressure gradient was-1.0(-3.2,0)and 4.6(0,16.5)mmHg in respective groups(Z=-3.851,P<0.001).Moreover,the intracoronary forward pressure gradient showed significant difference between that before and after nicorandil medication(Z=-3.668,P<0.001 in systolic pressure gradient and Z=-3.530,P<0.001 in diastolic pressure gradient).Conclusions:No reflow during emergent coronary revascularization is significantly associated with local hemodynamic abnormalities in the coronary arteries.Intracoronary nicorandil administration at the distal segment of a coronary artery with an aspiration catheter could improve the microcirculatory dysfunction and resume normal coronary pressure gradient.Clinical trial registration:www.ClinicalTrials.gov(No.NCT 03600259).

Correlation between balloon release pressure and no-reflow in patientswith acute myocardial infarction undergoing direct percutaneouscoronary intervention

Background Balloon release pressure may increase the incidence of no reflow after direct percutaneous coronary intervention(PCI). This randomized controlled study was designed to analyze the correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction(AMI) undergoing direct PCI. Methods There were 156 AMI patients who underwent PCI from January 1, 2010 to December 31, 2012, and were divided into two groups according to the stent inflation pressure: a conventional pressure group and a high pressure group. After PCI, angiography was conducted to assess the thrombolysis in myocardial infarction(TIMI) grade with related artery. Examinations were undertaken on all patients before and after the operation including cardiac enzymes, total cholesterol, low-density lipoprotein, blood glucose, homocysteine, β-thromboglobulin(β-TG), Hamilton depression scale(HAMD) and self-rating anxiety scale(SAS). After interventional therapy, the afore-mentioned parameters in both the conventional pressure group and high pressure group were again analyzed. Results The results showed that CK-MB, HAMD, SAS were significantly different(P <0.05) in all patients after PCI, especially the CK-MB in the high pressure group((25.7±7.6) U/L vs.(76.7±11.8) U/L). CK-MB, HAMD, SAS, and β-TG were comparative before PCI but they were significantly changed(P <0.05) after intervention. No-reflow phenomenon occurred in 13 patients in the high pressure group, which was significantly higher than in the conventional pressure group(17.11% vs. 6.25%, P <0.05). Conclusion In stent implantation, using a pressure less than 1823.4 kPa balloon to release pressure may be the better choice to reduce the occurrence of no-reflow following direct PCI.

Postoperative adverse cardiac events in acute myocardial infarction with high thrombus load and best time for stent implantation

BACKGROUND Myocardial infarction is one of the most common types of coronary heart disease.It is mainly caused by the rupture of coronary atherosclerotic plaque,which leads to platelet agglutination and thrombosis.The occlusion of coronary arteries and vessels leads to insufficient myocardial blood supply,subsequently causing cardiac interstitial fibrosis,gradual enlargement of ventricles,and heart failure,which affects the quality of life and safety of patients.AIM To investigate the effects of emergency percutaneous interventional therapy(PCI)and delayed stenting in acute myocardial infarction with high thrombotic load and identify factors related to major adverse cardiovascular events(MACE).METHODS A total of 164 patients with acute myocardial infarction and high thrombotic load who received PCI were included.Of them,92 patients were treated with delayed stent implantation(delayed group)and 72 patients received emergency PCI(immediate group).Myocardial perfusion after stent implantation was compared between the two groups.Patients were followed up for 12 mo,and the occurrence of MACE was used as the endpoint.Univariate and multivariate models were used to analyze the factors affecting MACE occurrence.RESULTS After stent implantation,66(71.74%)patients in the delayed group and 40(55.56%)patients in the immediate group had thrombolysis in myocardial infarction(TIMI)flow grade 3(P<0.05),while 61(66.30%)patients in the delayed group and 39(54.17%)patients in the immediate group reached TIMI myocardial perfusion grade 3(P>0.05).MACE occurred in 29 patients.There were statistically significant differences between the MACE and non-MACE groups in diabetes rate,TIMI grading,stent implantation timing,intraoperative use of tirofiban,and the levels of white blood cells(WBC),neutrophils,red blood cell distribution width(RDW),and uric acid,and high-sensitivity C-reactive protein(hs-CRP)at admission(P<0.05).Logistic regression analysis showed that TIMI grade 3 and intraoperative use of tirofiban effectively reduced the risk of MACE(P<0.05),while immediate stent implantation,increased WBC,hs-CRP and RDW on admission increased the risk of MACE(P<0.05).CONCLUSION Delayed stent implantation outweighs emergency PCI in improving postoperative myocardial perfusion in acute myocardial infarction with high thrombotic load,and effectively reduces MACE in these patients.

Clinical significance of intra-aortic balloon pumping on no-reflow phenomenon of primary percutaneous coronary intervention for acute myocardial infarction

Background Percutaneous coronary intervention （PCI） is used as a treatment for acute myocardial infarction （AMI）, and one of its major complications is the angiographic no-reflow phenomenon （NR）. Although intra-aortic balloon pumping （IABP） is sometimes used in such patients to increase the diastolic coronary blood flow, there is little available information regarding the effects of IABP on the angiographic no-reflow phenomenon. Method Twenty-two AMI patient with NR were performed primary PCI between January 2006 and December 2009, of which 12 patients were selected for IABP therapy and the left 10 were selected as the control group by group procedure of odd and even days; We observed the vasoactive substance in both groups on the days of 1, 2, 3, 5, 7, 10 after the different interventions, which include plasma renin activity （PRA）, angiotensin Ⅱ （ANG Ⅱ）, aldosterone （ALD）, adrenaline （E）, and noradrenalin （NE）; In addition, cardiac structure and cardiac ventricle systolic function including left atrium medial diameter （LAMD）, left ventricular medial diameter （LVMD） Finally, left ventricular ejection fraction （LVEF） were evaluated after 10 days, 3 months and 6 months; statistics was taken to analysis. Results According to the time concentration curve, vasoactive substance of the IABP group decreased faster than that of the control group, and this difference had statistical significance （P 〈 0.01 ） ; In terms of LAMD, LVMD, and LVEF, echocardiography difference of the IABP and the control group in 10 days, 3 months, and 6 months also showed statistical significance （P 〈 0.05）. Conclusions IABP can significantly reduce the release of vasoactive substances of NR in patients of primary PCI for AMI; LAMD, LVMD and LVEF in 10 days, 3 months, and 6 months can be improved using this method, which is conducive to recovery of heart function.

胸痛智能化平台的构建及在ST段抬高型心肌梗死患者中的应用

目的通过胸痛智能化平台的构建及应用,探讨其在急性ST段抬高型心肌梗死患者救治效率及临床预后的影响。方法由多学科成员组成胸痛智能化平台管理小组,将院前急救系统、医院电子病历系统、检验科信息系统、影像归档和通信系统融为一体,构建胸痛智能化平台并将其应用于急性ST段抬高型心肌梗死患者的救治与护理。选取2021年4月—2023年5月在深圳市某三级甲等医院急诊科就诊的急性ST段抬高型心肌梗死患者172例,以应用胸痛智能化平台前后分为对照组和试验组各86例,比较两组救治时间、效率及预后等指标的差异。结果应用胸痛智能化平台后,试验组发病至首次医疗接触时间、首次医疗接触至导丝通过时间、进医院大门至导丝通过时间、首次医疗接触至使用双联抗血小板治疗时间、入门至造影时间均显著低于对照组,差异具有统计学意义(均P<0.05)。试验组患者出院时的氨基末端B型脑钠肽前体水平显著低于对照组(P<0.05),但两组出院时左心室射血分数差异无统计学意义(P=0.828)。结论应用胸痛智能化平台可缩短急性ST段抬高型心肌梗死患者救治各环节的时间,提高救治效率,改善患者预后。

老年急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后延长应用替格瑞洛对临床转归的影响

目的探讨老年(年龄≥65岁)急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后延长应用替格瑞洛对临床转归的影响。方法纳入2018年2月至2021年2月在秦皇岛市第一医院行PCI后接受替格瑞洛+阿司匹林双联抗血小板治疗(DAPT)的≥65岁急性STEMI患者105例(应用DAPT评分系统评估均≥2分),在阿司匹林长期用药基础上,根据患者服用替格瑞洛时间不同分为对照组(n=37,使用时间为PCI治疗后1年)与观察组(n=68,在对照组基础上再延长替格瑞洛治疗1年),其中观察组根据延长应用替格瑞洛的剂量不同又分为2个亚组,即观察A组(n=40,标准剂量,90 mg/次,每日2次)和观察B组(n=28,小剂量,45 mg/次,每日2次)。比较3组患者急诊PCI术后心肌梗死溶栓治疗(TIMI)3级血流、心电图完全回落比例、血栓弹力图中的血小板功能(MA)、二磷酸腺苷诱导的血小板聚集率;随访1年,主要不良心脑血管事件(MACCE)、出血事件发生情况。采用SPSS 25.0软件进行数据分析。根据数据类型,组间比较采用t检验、χ^(2)检验。结果PCI术后,观察A、B组的TIMI 3级血流患者比例显著高于对照组(χ^(2)=4.699、4.353;P=0.030、0.036),而观察A组与观察B组组间差异无统计学意义。PCI治疗后2年,观察A、B组血栓弹力图中的MA值、二磷酸腺苷诱导的血小板聚集率明显低于对照组(t=8.752、6.524;均P<0.001),但观察A组、观察B组比较差异无统计学意义。随访1年,3组总MACCE发生率比较差异有统计学意义(χ^(2)=4.354;P=0.039),其中观察组A、B组MACCE发生率均显著低于对照组(χ^(2)=4.769、5.082;P=0.028、0.024),但观察A组与观察B组间差异无统计学意义;3组患者出血事件发生率差异均无统计学意义。结论老年(≥65岁)STEMI患者(DAPT评分≥2分)PCI后延长应用替格瑞洛可能降低主要不良心脑血管事件发生率,且小剂量(45mg/次)替格瑞洛并未增加出血发生的风险,仍需长期随访观察进一步证实。

No-reflow protection and long-term efficacy for acute myocardial infarction with Tongxinluo： a randomized double-blind placebo- controlled multicenter clinical trial （ENLEAT Trial）

Background No-reflow after emergency percutaneous coronary intervention （PCI） for acute ST segment elevation myocardial infarction （STEMI） is related to the severe prognosis. The aim of this study was to evaluate the efficacy of Tongxinluo, a traditional Chinese medicine, on no-reflow and the infarction area after emergency PCI for STEMI.Methods A total of 219 patients （female 31, 14%） undergoing emergency PCI for STEMI from nine clinical centers were consecutively enrolled in this randomized, double-blind, placebo-controlled, multicenter clinical trial from January 2007 to May 2009. All patients were randomly divided into Tongxinluo group （n=108） and control group （n=111）, given Tongxinluo or placebo in loading dose 2.08 g respectively before emergency PCI with asprin 300 mg and clopidogrel 300 mg together, then 1.04 g three times daily for six months after PCI. The ST segment elevation was recorded by electrocardiogram at hospitalization and 1, 2, 6, 12, 24 hours after coronary balloon dilation to evaluate the myocardial no-flow; myocardial perfusion scores of 17 segments were evaluated on day 7 and day 180 after STEMI with static single-photon emission computed tomography （SPECT） to determine the infarct area.Results There was no statistical significance in sex, age, past history, chest pain, onset-to-reperfusion time, Killip classification, TIMI flow grade just before and after PCI, either in the medication treatment during the follow up such as statin, β-blocker, angiotensin converting enzyme inhibitor （ACEI） or angiotensin receptor blocker （ARB） between two groups. There was significant ST segment restoration in Tongxinluo group compared to the control group at 6 hours （（-0.22±0.18） mV vs. （-0.18±0.16） mV, P=0.0394）, 12 hours （（-0.24 ± 0.18） mV vs. （-0.18±0.15） mV, P=0.0158） and 24 hours （（-0.27±0.16） mV vs. （-0.20±0.16） mV, P=0.0021） reperfusion; and the incidence of myocardial no-reflow was also reduced significantly at 24-hour reperfusion （34.3% vs. 54.1%, P=0.0031）. The myocardial perfusion scores of 17 segments evaluated by static SPECT was improved significantly on day 7 and day 180 after STEMI in Tongxinluo group compared to the control group （0.61±0.40 vs. 0.76±0.42, P=0.0109 and 0.51 ±0.42 vs. 0.66±0.43, P=0.0115, respectively）.There was no significant difference in severe adverse events between two groups.Conclusion Tongxinluo as a kind of traditional Chinese medicine could reduce myocardial no-reflow and infarction area significantly after emergency PCl for STEMI with conventional medicine therapy.

碘克沙醇在STEMI患者急诊PCI术中应用的有效性和安全性

目的探讨碘克沙醇在ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗PCI术中应用的有效性和安全性。方法选取2020年1月至2020年12月于河北省人民医院收治的行急诊PCI的STEMI患者80例,根据术中应用的造影剂种类分为实验组(碘克沙醇)和对照组(碘佛醇),每组各40例。收集患者的基线资料,观察两组患者的血管影像质量、不良反应,记录术后48~72 h的血清肌酐(SCr)、估算的肾小球滤过率(eGFR)。术后30 d随访,记录靶病变再次血运重建、卒中、支架内血栓、心源性死亡及心肌梗死等事件的发生。结果两组患者临床基本资料无显著差异(P>0.05),血管影像结果均清晰。两组间围手术期不良反应发生率、术前术后SCr、eGFR均无明显差异(P>0.05),但对照组术后SCr水平较术前增高[(91.52±33.83)μmol/L vs.(76.89±16.89)μmol/L,P<0.05],而实验组SCr水平无明显变化。结论碘克沙醇在STEMI患者急诊PCI术中对肾功能影响较小,更为安全。

PERMA模式护理干预对急诊经皮冠脉介入术后患者运动恐惧和心理弹性的效果

目的探讨PERMA模式护理干预对急性心肌行经皮冠脉介入(PCI)术后患者运动恐惧和心理弹性的影响。方法选取160例急诊PCI术后患者为研究对象,随机分为对照组(80例)和观察组(80例)。对照组予以常规护理,观察组在常规护理的基础上实施基于PERMA模式护理干预。在入院第2天和干预6周后采用运动恐惧量表和心理弹性量表进行效果评价。结果护理干预6周后,观察组TSK-Heart-C量表的害怕受伤、自身功能下降、避免运动、感知到心脏危险4个得分及总分均明显降低,且观察组干预6周后的总分低于对照组,P<0.05。护理干预6周后,观察组CD-RISC量表中坚韧、自强、乐观维度得分及总分均增加,P均<0.05,且观察组上述得分均高于对照组,P<0.01。结论PERMA模式护理干预可以有效的降低患者运动恐惧程度,提高心理弹性水平,对改善急诊PCI术后患者心脏康复具有重要意义。

不同治疗时间窗对急性前壁心肌梗死患者行急诊冠脉介入治疗的效果

目的探讨不同治疗时间窗急性前壁心肌梗死急诊冠脉介入治疗对其效果的影响。方法选取2021年1月—2022年12月江南大学附属医院行急诊冠脉介入治疗的140例急性前壁心肌梗死患者,其中70例患者发病后至急诊冠脉介入治疗时间<3 h作为<3 h组,70例患者发病后至急诊冠脉介入治疗时间为3~8 h作为3~8 h组。术后,复查冠脉造影观察病变血管狭窄程度改善情况,评估治疗效果。结果<3 h组总有效率(98.57%,69/70)高于3~8 h组(84.29%,59/70)(P<0.05)。<3 h组治疗后心肌损害指标低于3~8 h组(P<0.05)。<3 h组治疗后左心室收缩末期内径、左心室舒张末期内径、左心房内径少于3~8 h组(P<0.05),左心室射血分数(52.36±4.24)%、二尖瓣口舒张早期血流速度峰值/舒张晚期血流速度峰值(early diastolic peak blood flow velocity of mitral valve opening/late diastolic peak blood flow velocity,E/A)(1.33±0.18)高于3~8 h组[(47.13±5.16)%、(1.29±0.20)](P<0.05)。随访6个月,2组均未见病死者;<3 h组心绞痛、心律失常、心源性休克等不良心血管事件发生次数均低于3~8 h组(P<0.05)。结论急性前壁心肌梗死发病早期尽早实施冠脉介入治疗,可改善患者预后,临床效果更佳。

急性心肌梗死患者急诊介入术后发生再灌注心律失常的危险因素分析

目的分析急性心肌梗死(AMI)患者急诊介入术后发生再灌注心律失常的危险因素。方法统计108例AMI患者急诊介入术后再灌注心律失常发生情况,探讨术后发生再灌注心律失常的危险因素。结果108例AMI患者急诊介入术后再灌注心律失常发生率为43.52%。单因素和Logistics回归分析显示,Killip分级Ⅲ级、下壁梗死、病变血管血流TIMI分级0级、发病6h内进行介入术治疗是急诊介入术后发生再灌注心律失常的危险因素(P<0.05)。结论AMI患者急诊介入术后发生再灌注心律失常的风险较高,其危险因素包括Killip分级Ⅲ级、下壁梗死、病变血管血流TIMI分级0级、发病6 h内进行介入术治疗。

不同剂量替罗非班对老年急性ST段抬高型心肌梗死术后患者的临床应用研究

目的:探讨不同剂量替罗非班对老年急性ST段抬高型心肌梗死(STEMI)术后患者的影响。方法:选取2020年2月—2022年10月确诊为老年STEMI并行经皮冠状动脉(以下简称冠脉)介入术(PCI)患者97例,按照随机数字表法分为全量组(n=48)和半量组(n=48)。全量组经导管冠脉内注射替罗非班10μg/kg联合术后0.15μg·kg^(-1)·min^(-1)静脉泵入;半量组经导管冠脉内注射替罗非班5μg/kg联合术后0.07μg·kg^(-1)·min^(-1)静脉泵入。观察两组心肌酶指标、PCI后冠脉血流情况、不良反应及主要不良心血管事件(MACE)发生情况。结果:术后24 h,两组肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白T(cTnT)均低于术前,差异有统计学意义(P<0.05),两组比较,差异无统计学意义(P>0.05);两组血流分级(TIMI)3级、ST段回落、校正的TIMI帧数(CTFC)、无复流/慢血流等情况比较,差异无统计学意义(P>0.05);半量组出血不良反应发生率低于全量组,差异有统计学意义(P<0.05);两组MACE发生率比较,差异无统计学意义(P>0.05)。结论:应用半剂量的替罗非班出血不良发生率更低,安全性更高。

胸痛中心认证对急性ST段抬高型心肌梗死患者救治效率及临床预后的影响

目的研究胸痛中心认证对行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者救治效率和临床预后的影响。方法选取2021年10月至2023年8月于邵阳市中心医院胸痛中心行急诊PCI治疗的192例急性STEMI患者,将胸痛中心认证前(2021年10月至2022年7月)89例患者设为对照组,胸痛中心认证后(2022年8月至2023年8月)的103例患者设为观察组,比较两组患者救治关键时间节点、临床预后相关指标、住院时间和住院费用的差异。结果相较于对照组,观察组患者的进门-球囊扩张时间、发病至首次医疗接触时间、发病至球囊扩张时间、首次医疗接触至球囊扩张时间、首次医疗接触至双联抗血小板时间、首次医疗接触至首份心电图完成时间、肌钙蛋白报告时间、导管室激活时间均显著缩短,住院费用及院内心力衰竭发生率均降低,左室射血分数增加,差异均有统计学意义(均P<0.05)。两组患者住院时间、病死率差异均无统计学意义(均P>0.05)。结论胸痛中心认证显著缩短了经PCI治疗STEMI患者的血管复通时间,提高了救治效率,降低了患者心力衰竭发生率与经济负担,改善了患者临床预后。

In-hospital delay to primary angioplasty for patients with ST-elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.

Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China

Background:Reduced application of percutaneous coronary intervention(PCI)is associated with higher mortality rates after STsegment elevation myocardial infarction(STEMI).We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.Methods:We studied 957 patients diagnosed with STEMI in the emergency departments(EDs)of six public hospitals in China.The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI.Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.Results:The potential factors contributing to refusing PCI were older than 65 years(odds ratio[OR]2.66,95%confidence interval[Cl]1.56-4.52,P<0.001),low body mass index(BMI)(OR 0.91,95%Cl 0.84-0.98,P=0.013),not being married(OR 0.29,95%Cl 0.17-0.49,P<0.001),history of myocardial infarction(MI)(OR 2.59,95%Cl 1.33-5.04,P=0.005),higher heart rate(HR)(OR 1.02,95%Cl 1.01-1.03,P=0.002),cardiac shock in the ED(OR 5.03,95%Cl 1.48-17.08,P=0.010),pre-hospital delay(>12 h)(OR 3.31,95%Cl 1.83-6.02,P<0.001)and not being hospitalized in a tertiary hospital(OR 0.45,95%Cl 0.27-0.75,P=0.002).Compared to men,women were older,were less often married,had a lower BMI and were less often hospitalized in tertiary hospitals.Conclusions:Patients who were older,had lower economic or social status,and had poorer health status were more likely to refuse PCI after STEMI.There was a sex difference in the potential predictors of refusing PCI.Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.

ECMO支持下治疗急性心肌梗死合并心源性休克患者的预后分析

目的分析体外膜肺氧合(ECMO)支持下治疗急性心肌梗死(AMI)合并心源性休克(CS)患者的预后情况及其影响因素.方法回顾性分析2018年12月至2021年12月于河北医科大学第二医院急诊医学科就诊的ECMO支持下行冠状动脉(冠脉)造影及经皮冠脉介入(PCI)治疗AMI合并CS患者的临床资料,包括性别、年龄、体质指数(BMI);既往史(吸烟、冠心病、糖尿病、高血压、高脂血症、脑血管病);急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)、血管活性药物评分(VIS);上ECMO前24h内最差辅助检查指标:血乳酸、白细胞计数(WBC)、心肌肌钙蛋白I(cTnI)、丙氨酸转氨酶(ALT)、总胆红素(TBil)、肌酐(Cr)、血清钾(K^(+))、左室射血分数(LVEF);发病至PCI时间;冠脉造影结果(是否累及前降支、回旋支、右冠脉,是否为三支病变、是否为左主干病变);是否应用主动脉内球囊反搏(IABP)、是否应用连续性肾脏替代治疗(CRRT).根据发病30d的预后情况将患者分为存活组和死亡组,单因素分析比较不同预后两组上述指标的差异,采用Logistic回归分析影响ECMO支持下行冠脉造影及PCI治疗AMI合并CS患者预后的独立危险因素,并绘制受试者工作特征曲线(ROC曲线)评价各危险因素对患者预后的预测价值.结果39例患者中30d存活21例(53.8%),死亡18例(46.2%);与存活组比较,死亡组VIS评分、血乳酸、发病至PCI时间、累及回旋支、三支病变、左主干病变患者比例均明显升高(均P<0.05).Logistic回归分析显示,血乳酸、三支病变是影响AMI合并CS患者30d预后的独立危险因素[优势比(OR)和95%可信区间(95%CI)分别为1.845(1.018~3.342)、107.171(1.307~8785.901),均P<0.05];ROC曲线分析显示:血乳酸和三支病变对ECMO支持下行冠脉造影及PCI治疗AMI合并CS患者的预后均有预测价值,ROC曲线下面积(AUC)为0.756和0.752,95%CI为0.601~0.911和0.588~0.916,P值为0.007和0.008;当乳酸的截断值为5 mmol/L时,其预测行冠脉造影及PCI治疗AMI合并CS患者预后的敏感度为94.1%,特异度为57.1%.结论AMI合并CS的危重患者应用ECMO的指征需进一步细化.VIS评分、乳酸、发病至PCI时间、三支病变及左主干病变等是患者死亡的风险因素,高乳酸、高VIS评分、三支病变等情况行ECMO支持时应慎重.对于合适的患者尽早行ECMO支持,降低乳酸、减少血管活性药物应用及缩短发病至PCI时间一定程度上能改善患者预后.