BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac bio...BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.展开更多
Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients re...Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.展开更多
Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currentl...Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.展开更多
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 pat...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.展开更多
Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,adva...Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.展开更多
Objective The coronaryanatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied. Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG...Objective The coronaryanatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied. Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG) was performed at 90 minuts and again at 3 to 4 weeks. Results Successful thrombolysis occurred in 60 cases, but failed in 40. The ratio of reperfusion was 60%. CAG showed there were residual thrombi in 84 patients (84% ) and complete coronary occlusion in 40(40% ). Angiography at 3 to 4 weeks after thrombolysis showed the stenosis worsened in 8 patients and improved in 10. Conclusion AMI is caused by sudden coronary thrombotic occlusion and can be reperfused by using thrombolytic agent or mechanical methods. Throm-bolytic agents usually can not resolve thrombi completely. So percutaneous transluminal coronary angiography (PTCA) is recommended as an important method to improve serious residual stenosis.展开更多
The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population. Intravenous thrombolytic therapy (TT) is the most common strategy for the treatment of...The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population. Intravenous thrombolytic therapy (TT) is the most common strategy for the treatment of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.(J Geriatr Cardiol 2007;4:250-253.)展开更多
ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the c...ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.展开更多
Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditiona...Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditional stent implantation in patients with acute ST-segment elevation myocardial infarction.Methods:From January 2018 to October 2019,184 patients diagnosed with acute ST-segment elevation myocardial infarction and infarction-related arterial blood flow TIMI 0 grade in the First Affiliated Hospital of Hainan Medical College and percutaneous coronary intervention(PCI)were selected.According to different surgical methods,patients were divided into intracoronary retrograde thrombolysis combined with stent implantation group(thrombolysis group,n=57 cases),thrombus aspiration combined with stent implantation group(aspiration group,n=57 cases)),traditional stent implantation group(traditional group,n=70 cases).Compare the incidence of no-reflow phenomenon after percutaneous coronary intervention,the rate of 1 hour ST_segment fall≥50%in the ECG after PCI,and the main adverse cardiovascular events(MACE)during hospitalization;compare the left ventricular end-diastolic diameter(LVEDD)、left ventricular ejection fraction(LVEF)and major adverse cardiovascular events at 1 year after PCI.Results:1.The short-term effects:The incidence of no-reflow phenomenon in the thrombolytic group was lower than that of the aspiration group and the traditional group,and the rate of 1hSTR≥50%was higher than that of the aspiration group and the traditional group,the difference was statistically significant(P<0.05).2.The long-term effects:1 year after percutaneous coronary intervention,the LVEDD of the thrombolytic group was lower than that of the aspiration group and the traditional group,while the LVEF was higher than the aspiration group and the traditional group,and the incidence of major adverse cardiovascular events in the thrombolytic group at was lowest,both the difference was statistically significant(P<0.05).Conclusion:The application of intracoronary retrograde thrombolysis combined with stent implantation in STEMI patients can reduce the occurrence of no-reflow,improve long-term cardiac function,and reduce the occurrence of major adverse cardiovascular events for short-term and long-term.展开更多
Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardia...Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.展开更多
Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute m...Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute myocardial infarction(AMI) received 1.5 or 2.0 mulliou U nonspecific urokinase(UK),or 70-80 mg fibrin-specific fecombinant tissue plasminogen activator(rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents.Eight patients with AMI an without thrombolytic therapy were enrolled as controls.Coagulant and thrombolytic activity markers included thrombin-antithrombin Ⅲ comlex(TAT),D-dimer,fibrinogen(Fg) ,FMPV/Amax.All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic agents respectively.Results.Molecular marker of thrombin generation-TAT showed an activated coagulant state immediately after thrombolytic therapy.Level of TAT showed no significant changes between every two osbserved phases in controls.Howver,level of TAT increased significantly from 4.95±1.75μg/L(4.63±1.37μg/L) to 14.71±3.31μg/L(14.25±2.53μg/L) before and immediately after administration of thrombolytic agents UK(or rt-PA).There was significant difference between level of serum TAT of patients with and without thrombolytic therapy,and higher EMPV/Amax level than controls.D-dimer,a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therap(P<0.05).Couclusions.Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy.Both urokinase and rt-PA had procoagulant action.This transient activation of the coagulant system might contribute to early reocclusion.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.展开更多
Purpose: To describe the epidemiological, clinical and management characteristics of acute coronary syndromes (ACS) in Thies, Senegal. Methods: This was a prospective study that included consecutively from Octobe...Purpose: To describe the epidemiological, clinical and management characteristics of acute coronary syndromes (ACS) in Thies, Senegal. Methods: This was a prospective study that included consecutively from October 1<sup>st</sup>, 2018 to March 03<sup>rd</sup>, 2019, patients aged 18 years or older admitted for an ACS at the DIABCARMET department of the Saint Jean de Dieu Hospital in Thies. Results: Of the 516 patients admitted, 29 had ACS, the prevalence was 5.62%. The average age of the patients was 64.2 ± 11.6 years. Nineteen patients (65.5%) were male and 10 (34.5%) were female, the sex ratio was 1.91. The number of direct admissions was 18 (62%) versus 11 patients (38%) referred. The mode of transport was a private vehicle in 19 patients (65.5%), an ambulance in 7 patients (24.1%) and public transport in 3 patients (10.3%). STEMI (ST segment elevation myocardial infarction) was the most common presentation observed in 19 patients (65.5%). Fifteen patients (51.7%) were admitted before the 12<sup>th</sup> hour. Of the 19 patients with STEMI, 11 (57.9%) had arrived in hospital before the 12<sup>th</sup> hour and 10 patients had streptokinase thrombolysis. No patients received primary PCI. Ten patients (34.5%) had heart failure and five patients (17.2%) died during hospitalization. Conclusion: Delayed consultation and high mortality characterize ACS in Thies. Prevention must be the rule.展开更多
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers.Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity.In patients with STEMI who could not receive primary percutaneous coronary intervention(PCI)on time,pharmacoinvasive strategy(thrombolysis followed by timely PCI within 3-24 h of its initiation)is an effective option.AIM To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis.METHODS This was a physician-initiated,single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries.Patients received routine pharmacoinvasive therapy(PCI within 3-24 h of thrombolysis)in one group and delayed pharmacoinvasive therapy(PCI within 24-72 h of thrombolysis)in another group.The primary endpoint was major adverse cardiac and cerebrovascular events(MACCE)within 30 d of the procedure.The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification,angina,and dyspnea within 30 d.RESULTS The mean age in the two groups was comparable(55.1±10.1 years vs 54.2±10.5 years,P=0.426).Diabetes was present among 20.2%and 22.1%of patients in the routine and delayed groups,respectively.Smoking rate was 54.6%and 55.8%in the routine and delayed groups,respectively.Thrombolysis was initiated within 6 h of onset of symptoms in both groups(P=0.125).The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9±5.3 h and 44.1±14.7 h,respectively.No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d(8.7%vs 12.9%,P=0.152).Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation.Secondary endpoints such as angina,dyspnea,and major bleeding were non-significantly different between the two groups.CONCLUSION Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
文摘Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.
基金supported by the Hainan Province’s Key Research and Development Project(ZDYF 2017096&ZDYF2018118)National Natural Science Foundation of China(NSFC:81500202)+2 种基金Beijing Lisheng Cardiovascular Health Foundation Pilot Fund Project(LHJJ201610620)Provincial Key Science and Technology Projects supporting projects in Sanya(2018PT48)Sanya Medical and Health Science and Technology Innovation Project(2017YW10)
文摘Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
文摘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.
文摘Intracerebral hemorrhage secondary to thrombolysis in patients with acute myocardial infarction is a catastrophic condition.Several factors predispose to intracranial bleeding including low body weight,female sex,advanced age,use of oral anticoagulants prior to the administration of fibrinolytic therapy,diastolic blood pressure (greater than 110 mm Hg),among others.Optimal medical management involves multidisciplinary roles of hematology,neurosurgery and critical medicine.In this illustrative case,a classification and management algorithm were proposed for patients with complications hemorrhage associated with thrombolysis after myocardial infarction.
文摘Objective The coronaryanatomic feature and development after thrombolysis in acute myocardial infarction (AMI) were studied. Mehtods 100 patients with AMI received urokinase and strepokinase. Coronary angiography (CAG) was performed at 90 minuts and again at 3 to 4 weeks. Results Successful thrombolysis occurred in 60 cases, but failed in 40. The ratio of reperfusion was 60%. CAG showed there were residual thrombi in 84 patients (84% ) and complete coronary occlusion in 40(40% ). Angiography at 3 to 4 weeks after thrombolysis showed the stenosis worsened in 8 patients and improved in 10. Conclusion AMI is caused by sudden coronary thrombotic occlusion and can be reperfused by using thrombolytic agent or mechanical methods. Throm-bolytic agents usually can not resolve thrombi completely. So percutaneous transluminal coronary angiography (PTCA) is recommended as an important method to improve serious residual stenosis.
文摘The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population. Intravenous thrombolytic therapy (TT) is the most common strategy for the treatment of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.(J Geriatr Cardiol 2007;4:250-253.)
文摘ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.
文摘Objective:To evaluate the short-term and long-term curative effects of precise intracoronary retrograde thrombolysis combined with stent implantation,thrombus aspiration combined with stent implantation,and traditional stent implantation in patients with acute ST-segment elevation myocardial infarction.Methods:From January 2018 to October 2019,184 patients diagnosed with acute ST-segment elevation myocardial infarction and infarction-related arterial blood flow TIMI 0 grade in the First Affiliated Hospital of Hainan Medical College and percutaneous coronary intervention(PCI)were selected.According to different surgical methods,patients were divided into intracoronary retrograde thrombolysis combined with stent implantation group(thrombolysis group,n=57 cases),thrombus aspiration combined with stent implantation group(aspiration group,n=57 cases)),traditional stent implantation group(traditional group,n=70 cases).Compare the incidence of no-reflow phenomenon after percutaneous coronary intervention,the rate of 1 hour ST_segment fall≥50%in the ECG after PCI,and the main adverse cardiovascular events(MACE)during hospitalization;compare the left ventricular end-diastolic diameter(LVEDD)、left ventricular ejection fraction(LVEF)and major adverse cardiovascular events at 1 year after PCI.Results:1.The short-term effects:The incidence of no-reflow phenomenon in the thrombolytic group was lower than that of the aspiration group and the traditional group,and the rate of 1hSTR≥50%was higher than that of the aspiration group and the traditional group,the difference was statistically significant(P<0.05).2.The long-term effects:1 year after percutaneous coronary intervention,the LVEDD of the thrombolytic group was lower than that of the aspiration group and the traditional group,while the LVEF was higher than the aspiration group and the traditional group,and the incidence of major adverse cardiovascular events in the thrombolytic group at was lowest,both the difference was statistically significant(P<0.05).Conclusion:The application of intracoronary retrograde thrombolysis combined with stent implantation in STEMI patients can reduce the occurrence of no-reflow,improve long-term cardiac function,and reduce the occurrence of major adverse cardiovascular events for short-term and long-term.
基金512 Talent Culture Planning(No.by51201317,by51201105)Innovation Team of Basic and Clinical Application for Cardiovascular Injury and Protection(No.BYKC201906)+1 种基金Technology and Science Innovation Team of Bengbu Medical College(No.BYJC201901)Natural Science Research Key Programm of Bengbu Medical College(No.2020byzd109)。
文摘Objective:To analyze the clinical characteristics of patients with type 2 diabetes mellitus(T2DM)with acute coronary syndrome(ACS),the global registry of acute coronary events(GRACE)score,the thrombolysis in myocardial infarction(TIMI)score and clinical prognosis.Method:The study was a retrospective one-center observational study,continuous inclusion of 600 ACS patients diagnosed by coronary angiography in our hospital from October 2018 to July 2019.Collect general clinical data,laboratory examination results,imaging data and interventional treatment data of all patients.Were divided into:T2DM with ACS group(group DA)and non-T2DM with ACS(group NDA)according to whether or not they were associated with T2DM.According to the GRACE、TIMI score,the two groups were divided into high risk group,middle risk group and low risk group.All patients underwent coronary angiography to calculate the number of vascular lesions and Gensini scores.Design questionnaire,after discharge to 2 groups of patients by telephone or outpatient follow-up average of 10 months,statistics of the occurrence of MACE events.Result:Among the 600 patients included in the study,362 were male(60.3%)and 238 were female(39.7%)with mean age(64.7±10.3)years.The baseline data showed that the G、TG、UA、CR levels were higher in the DA group than in the NDA group;the proportion of men was lower than in the NDA group.The results of coronary angiography showed that the Gensini score of DA group was higher than that of NDA group,and the proportion of single lesion was lower than that of NDA group.The binary Logistic regression analysis suggested that age and CRP were independent risk factors for MACE events in patients with T2DM.GRACE risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,and there was no significant difference between low and middle risk group.TIMI risk stratification showed that the proportion of high risk group in DA group was significantly higher than that in NDA group,while the proportion of low and middle risk group was lower than that in NDA group.The ROC curve shows that the area(AUC)below the ROC curve that GRACE、TIMI score predicted the occurrence of MACE events in patients with T2DM and ACS was 0.707 and 0.586.Conclusion:Patients with T2DM and ACS had higher clinical risk stratification than without T2DM.GRACE score compared with the TIMI score had better predictive value for the occurrence of MACE events after discharge of T2DM with ACS patients.
文摘Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute myocardial infarction(AMI) received 1.5 or 2.0 mulliou U nonspecific urokinase(UK),or 70-80 mg fibrin-specific fecombinant tissue plasminogen activator(rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents.Eight patients with AMI an without thrombolytic therapy were enrolled as controls.Coagulant and thrombolytic activity markers included thrombin-antithrombin Ⅲ comlex(TAT),D-dimer,fibrinogen(Fg) ,FMPV/Amax.All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic agents respectively.Results.Molecular marker of thrombin generation-TAT showed an activated coagulant state immediately after thrombolytic therapy.Level of TAT showed no significant changes between every two osbserved phases in controls.Howver,level of TAT increased significantly from 4.95±1.75μg/L(4.63±1.37μg/L) to 14.71±3.31μg/L(14.25±2.53μg/L) before and immediately after administration of thrombolytic agents UK(or rt-PA).There was significant difference between level of serum TAT of patients with and without thrombolytic therapy,and higher EMPV/Amax level than controls.D-dimer,a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therap(P<0.05).Couclusions.Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy.Both urokinase and rt-PA had procoagulant action.This transient activation of the coagulant system might contribute to early reocclusion.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.
文摘Purpose: To describe the epidemiological, clinical and management characteristics of acute coronary syndromes (ACS) in Thies, Senegal. Methods: This was a prospective study that included consecutively from October 1<sup>st</sup>, 2018 to March 03<sup>rd</sup>, 2019, patients aged 18 years or older admitted for an ACS at the DIABCARMET department of the Saint Jean de Dieu Hospital in Thies. Results: Of the 516 patients admitted, 29 had ACS, the prevalence was 5.62%. The average age of the patients was 64.2 ± 11.6 years. Nineteen patients (65.5%) were male and 10 (34.5%) were female, the sex ratio was 1.91. The number of direct admissions was 18 (62%) versus 11 patients (38%) referred. The mode of transport was a private vehicle in 19 patients (65.5%), an ambulance in 7 patients (24.1%) and public transport in 3 patients (10.3%). STEMI (ST segment elevation myocardial infarction) was the most common presentation observed in 19 patients (65.5%). Fifteen patients (51.7%) were admitted before the 12<sup>th</sup> hour. Of the 19 patients with STEMI, 11 (57.9%) had arrived in hospital before the 12<sup>th</sup> hour and 10 patients had streptokinase thrombolysis. No patients received primary PCI. Ten patients (34.5%) had heart failure and five patients (17.2%) died during hospitalization. Conclusion: Delayed consultation and high mortality characterize ACS in Thies. Prevention must be the rule.