Background ST segment elevation myocardial infarction （STEMI） remains a major cause of death world-wide. The thrombolysis in myocardial infarction （TIMI） risk score is a risk assessment tool to detect high risk ST...Background ST segment elevation myocardial infarction （STEMI） remains a major cause of death world-wide. The thrombolysis in myocardial infarction （TIMI） risk score is a risk assessment tool to detect high risk STEMI patients. NT-proBNP has been used to assess the severity of heart failure. However, the predictive power of TIMI risk score is not high enough to identify all high-risk patients, and whether NT-proBNP adds power to the TIMI risk score for predicting in-hospital mortality is unclear. Methods 664 STEMI patients were included and divided into 3 groups according to TIMI risk score ≤3 （n=211）, 4-6 （n=281）, and ≥7 （n=172）. The relation-ships between TIM! risk score and events were evaluated. The modified TIMI risk score was constructed through multivariate logistic regression analysis. Results The proportion of in-hospital death （0.5% vs. 3.2% vs. 10.5%, P〈0.001） and major adverse clinical events （MACEs） （14.2% vs. 22.8% vs. 40.1%, P〈0.001） increased as higher TIMI risk score was. ROC curve showed that the AUC of NT-proBNP for predicting in-hospital death was 0.792, with optimal cut-off being 3500pg/mL. Multivariate logistic regression analysis revealed that TIMI risk score （OR=1.26, 95% CI 1.05-1.50, P=0.012） and NT-proBNP〉3500pg/mL （OR=7.30, 95% CI 2.56-20.83, P〈0.001） were independently associated with in-hospital death. Adding NT-proBNP to TIMI risk score produced higher predictive value （AUC： 0.871 vs. 0.804, P=0.040）. Conclusion NT-proBNP is associated with in-hospital death in STEMI patients and has an additive prognostic value to TIMI risk score.展开更多
Background The incremental predictive value of red cell distribution width （RDW） on Korea Acute Myocardial Infarction Registry （KAMIR） score in patients with ST segment elevation myocardial infarction （STE- MI） ...Background The incremental predictive value of red cell distribution width （RDW） on Korea Acute Myocardial Infarction Registry （KAMIR） score in patients with ST segment elevation myocardial infarction （STE- MI） has not been assessed. This study was to investigate whether RDW had additional prognostic value on KA- MIR score for predicting in-hospital death of STEMI patients. Methods Seven hundred and seven STEMI patients were included in this study. The predictive value was evaluated using the receiver operating characteristic （ROC）. Multivariate logistic regression was used to determine risk predictors. Results Thirty four patients died while in hospital, who were older than those who survived, and had more proportion of Killip class/〉 2 and no in -hospital PCI. Blood glucose, serum creatinine, white blood cell count, RDW and KAMIR score were signifi- cantly higher in the Death group, among whom systolic blood pressure, hemoglobin and LVEF were lower. ROC curve analysis showed RDW could predict in-hospital death, with the optimal cut-off values being 14.1% （AUC=0.707, 95%CI, 0.618-0.796, P〈0.001）. When compared with the KAMIR score alone, the addition of RDW was associated with significant improvements in predicting in-hospital （AUC ： 0.865 vs. 0.839, P=0.039）. Conclusion RDW might provide additional information over the KAMIR score in STEMI patients.展开更多
Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or ...Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.展开更多
Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation...Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.展开更多
Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infar...Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.展开更多
Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,p...Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.展开更多
To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients ...To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients hospitalized between January 2017 and December 2021 were randomly assigned into two groups:the experimental group and the control group,each comprising 140 cases.The control group received ticagrelor combined with prourokinase thrombolysis,while the experimental group received ticagrelor combined with reteplase thrombolysis.The impact of these treatments on cardiac function and blood-related indexes in STEMI patients was assessed.Results revealed that CK-MB,AST,and LDH levels significantly decreased after 7 d of treatment compared to pre-treatment levels,with the experimental group exhibiting lower levels compared to the control group.Additionally,NT-pro BNP levels decreased in both groups after 24 h of treatment,with the experimental group showing a greater reduction compared to the control group.Furthermore,LVEF and E/A values significantly increased after 7 d of treatment in both groups,while LVEDd and LVESd values notably decreased,indicating improved cardiac function in the experimental group compared to the control group.Following treatment,levels of PT,TT,and APTT increased in both groups,while FIB levels decreased significantly,with noticeable differences between the two groups.The incidence of major adverse cardiovascular events(MACE)in the experimental group was significantly lower compared to the control group,although the rate of mild bleeding did not significantly differ.In conclusion,the combination of ticagrelor and reteplase demonstrated superior efficacy in reducing myocardial enzyme and NT-pro BNP levels,improving cardiac function,and enhancing safety compared to ticagrelor and prourokinase.These findings suggested that ticagrelor combined with reteplase thrombolysis held promise for clinical application.展开更多
Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary interventio...Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
文摘Background ST segment elevation myocardial infarction （STEMI） remains a major cause of death world-wide. The thrombolysis in myocardial infarction （TIMI） risk score is a risk assessment tool to detect high risk STEMI patients. NT-proBNP has been used to assess the severity of heart failure. However, the predictive power of TIMI risk score is not high enough to identify all high-risk patients, and whether NT-proBNP adds power to the TIMI risk score for predicting in-hospital mortality is unclear. Methods 664 STEMI patients were included and divided into 3 groups according to TIMI risk score ≤3 （n=211）, 4-6 （n=281）, and ≥7 （n=172）. The relation-ships between TIM! risk score and events were evaluated. The modified TIMI risk score was constructed through multivariate logistic regression analysis. Results The proportion of in-hospital death （0.5% vs. 3.2% vs. 10.5%, P〈0.001） and major adverse clinical events （MACEs） （14.2% vs. 22.8% vs. 40.1%, P〈0.001） increased as higher TIMI risk score was. ROC curve showed that the AUC of NT-proBNP for predicting in-hospital death was 0.792, with optimal cut-off being 3500pg/mL. Multivariate logistic regression analysis revealed that TIMI risk score （OR=1.26, 95% CI 1.05-1.50, P=0.012） and NT-proBNP〉3500pg/mL （OR=7.30, 95% CI 2.56-20.83, P〈0.001） were independently associated with in-hospital death. Adding NT-proBNP to TIMI risk score produced higher predictive value （AUC： 0.871 vs. 0.804, P=0.040）. Conclusion NT-proBNP is associated with in-hospital death in STEMI patients and has an additive prognostic value to TIMI risk score.
基金supported by Guangdong Provincial Department of Science and Technology(No:2015A020210061)
文摘Background The incremental predictive value of red cell distribution width （RDW） on Korea Acute Myocardial Infarction Registry （KAMIR） score in patients with ST segment elevation myocardial infarction （STE- MI） has not been assessed. This study was to investigate whether RDW had additional prognostic value on KA- MIR score for predicting in-hospital death of STEMI patients. Methods Seven hundred and seven STEMI patients were included in this study. The predictive value was evaluated using the receiver operating characteristic （ROC）. Multivariate logistic regression was used to determine risk predictors. Results Thirty four patients died while in hospital, who were older than those who survived, and had more proportion of Killip class/〉 2 and no in -hospital PCI. Blood glucose, serum creatinine, white blood cell count, RDW and KAMIR score were signifi- cantly higher in the Death group, among whom systolic blood pressure, hemoglobin and LVEF were lower. ROC curve analysis showed RDW could predict in-hospital death, with the optimal cut-off values being 14.1% （AUC=0.707, 95%CI, 0.618-0.796, P〈0.001）. When compared with the KAMIR score alone, the addition of RDW was associated with significant improvements in predicting in-hospital （AUC ： 0.865 vs. 0.839, P=0.039）. Conclusion RDW might provide additional information over the KAMIR score in STEMI patients.
基金supported by the National Key Research and Development Program of China(No.2022YFB380-7300)the National Natural Science Foundation of China(No.12471455)+2 种基金the Clinical Cohort Construction Program of Peking University Third Hospital(BYSYDL2022005)the Key Clinical Projects of Peking University Third Hospital(BYSYZD2023006)the Innovation&Transfer Fund of Peking University Third Hospital(BYSYZHKC2023-109).
文摘Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.
基金supported by the Beijing Tsinghua Changgung Hospital Fund(grant No.12019C1009).
文摘Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.
文摘Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.
文摘Objective To evaluate the effectiveness of Qishen Yiqi dripping pill(QYDP)in patients with non-STsegment elevation acute coronary syndrome(NSTE-ACS)after percutaneous coronary intervention(PCI).Methods A multicenter,prospective cohort study was conducted,enrolling 807 patients with NSTE-ACS who underwent PCI between 2012 and 2015.
文摘To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients hospitalized between January 2017 and December 2021 were randomly assigned into two groups:the experimental group and the control group,each comprising 140 cases.The control group received ticagrelor combined with prourokinase thrombolysis,while the experimental group received ticagrelor combined with reteplase thrombolysis.The impact of these treatments on cardiac function and blood-related indexes in STEMI patients was assessed.Results revealed that CK-MB,AST,and LDH levels significantly decreased after 7 d of treatment compared to pre-treatment levels,with the experimental group exhibiting lower levels compared to the control group.Additionally,NT-pro BNP levels decreased in both groups after 24 h of treatment,with the experimental group showing a greater reduction compared to the control group.Furthermore,LVEF and E/A values significantly increased after 7 d of treatment in both groups,while LVEDd and LVESd values notably decreased,indicating improved cardiac function in the experimental group compared to the control group.Following treatment,levels of PT,TT,and APTT increased in both groups,while FIB levels decreased significantly,with noticeable differences between the two groups.The incidence of major adverse cardiovascular events(MACE)in the experimental group was significantly lower compared to the control group,although the rate of mild bleeding did not significantly differ.In conclusion,the combination of ticagrelor and reteplase demonstrated superior efficacy in reducing myocardial enzyme and NT-pro BNP levels,improving cardiac function,and enhancing safety compared to ticagrelor and prourokinase.These findings suggested that ticagrelor combined with reteplase thrombolysis held promise for clinical application.
文摘Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
