Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9...Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.展开更多
Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome a...Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.展开更多
BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST...BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.展开更多
BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in c...BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used STATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation(ECMO)(OR:3.10 P<0.05)in the LC group were associated with increased mortality.Early PCI(-2.57 P<0.05)and Impella(-3.25 P<0.05)were also both associated with shorter LOS compared to those who did not.Early ECMO does not impact the LOS;however,it does increase total hospital charge(addition of$24717.85,P<0.05).CONCLUSION LC is associated with a significantly increased inpatient mortality,length of stay,and total hospital charges in patients who develop SRCS.Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges.The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care.Patients with early PCI had both shorter LOS and reduced inpatient mortality,while early Impella was associated with increased mortality and shorter LOS.Early ECMO is associated with increased mortality and higher total hospital charges.This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.展开更多
Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain nat...Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain natriuretic peptide(NT-pro-BNP)concentration and global acute coronary event register(GRACE)risk score in the prognosis of ST-segment elevation myocardial infarction(STEMI)patients,to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of STEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 118 confirmed STEMI patients who had received acute percutaneous coronary intervention(PCI).Thirty patients with STEMI were included in the major cardiac adverse events(MACEs)group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).The linear correlation analysis confirmed the relationship between NT-proBNP concentration and GRACE score.Results After adjustment for sex,history of current smoking,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that NT-proBNP concentration and GRACE score were the independent predictors for MACEs in STEMI patients who received PCI.Linear regression analysis showed that the level of NT-pro-BNP was positively correlated with GRACE score(r=0.612,P=0.000).The area under the curve(AUC)for GRACE,NT-pro-BNP and their combination were 0.757,0.723 and 0.782,respectively.Conclusions In a one-year follow-up,the concentration of NTpro-BNP and GRACE score were valuable of prediction for MACEs in STEMI patients who received PCI.In addition,NT-pro-BNP concentration was positively correlated with GRACE score.Additionally,the concentration of NT-pro-BNP could moderately enhance the GRACE score prediction of 1-year MACEs in STEMI patients who received PCI.展开更多
Background Low diastolic blood pressure(DBP)was reported to be associated with reduced coronary blood flow,subclinical myocardial damage,and cardiovascular events. The aim of this study was to explore the impact of lo...Background Low diastolic blood pressure(DBP)was reported to be associated with reduced coronary blood flow,subclinical myocardial damage,and cardiovascular events. The aim of this study was to explore the impact of low DBP on clinical outcomes in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI). Methods A total of 1232 patients with STEMI were retrospectively enrolled and divided into two groups according to admission DBP level:≥70 mm Hg(n=817)and < 70 mm Hg(n=415). The relationship between DBP and in-hospital and 1-year adverse events was evaluated.Results In-hospital death occurred in 2.4% of patients. The in-hospital mortality(5.3% vs. 1.0%,P<0.001)and major adverse clinical events(11.1% vs. 7.5%,P=0.033)were significantly higher in patients with a low DBP.DBP <70 mm Hg was associated with in-hospital death(adjusted odds rate=3.31,95%CI:1.36-8.07,P=0.009).Additional significant indicators included eGFR < 60 mL/min/1.73 m^2 and intra aorta balloon pump(IABP)treatment. Seventy-seven(6.3%)patients died in the one-year follow-up. DBP < 70 mm Hg was associated with increased risk of 1-year death(8.9% vs. 4.8%,Log-rank=9.9,P=0.002). Conclusion Low DBP was associated with increased risk of in-hospital and 1-year adverse prognosis in patients with STEMI undergoing PCI,which could be a tool for risk assessment.展开更多
BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-el...BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.展开更多
BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommende...BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.展开更多
Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significant...Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality.展开更多
Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC ...Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC and the prognosis for patients with ST-elevation myocardial infarction are not available.Methods Between January 2013 and December 2019,183 STEMI patients who attended in our center were retrospectively analyzed.All of the patients underwent primary percutaneous coronary intervention(PCI)and were with final TIMI grade 3 flow.Those patients were divided into high CTFC group(CTFC≥23 frames,n=76)and low CTFC group(CTFC<23 frames,n=107).The primary endpoint was the incidence of major adverse cardiovascular events(MACEs)after 12 months.Univariate and multivariate cox regression analysis was performed to figure out prognostic factors.Results A total of 183 individuals were included in this study.MACE rate was significantly higher in those patients with high CTFC(32.9%vs.15.7%,P=0.012),especially the revascularization rate(18.4%vs.2.8%,P=0.012).Multivariate Cox regression analysis showed that CTFC was the independent predictors of worse prognosis[risk ratio(RR):0.75,95%confidence interval(CI)0.67-0.82,P<0.001].Conclusions CTFC is feasible to identify the high-risk group after primary PCI for STEMI patients.High CTFC was associated with poor short-term clinical outcome.[S Chin J Cardiol 2021;22(1):7-12]展开更多
Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary interventio...Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]展开更多
Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the progno...Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with STEMI were included and divided into three groups according to the tertiles of NPR:<37(n=253),37-54(n=257),and≥54(n=257).Multivariate logistic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,P<0.001].The receiver operating characteristic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P<0.001,sensitivity=77.1%,specificity=69.0%,optimal cut-off value=54).As for 1-year mortality,multivariate Cox survival analysis revealed that NPR[hazard ratio(HR)=1.003,95%CI:1.001-1.004,P<0.001],as a continuous variable,and NPR>54(HR=2.70,95%CI 1.72-4.22,P<0.001),as a categorial variable,were both independent predictors for 1-year mortality.Conclusions NPR is a feasible predictor of poor prognosis for elderly patients with STEMI receiving PCI.展开更多
Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoi...Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention （PCI）. We compared the two treatments in this patient population.展开更多
BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technol...BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism.METHODS:The mononuclear cells were separated by ficoll centrifugation,and plasma total antioxidant capacity(T-AOC)was determined by the ferric reducing ability of plasma(FRAP)assay.The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction(qRT-PCR).Additionally,gene ontology(GO)enrichment analysis was performed on DAVID website to analyze the potential mechanism further.RESULTS:The total numbers of white blood cells(WBC)and neutrophils(N)in the peripheral blood of STEMI patients(the AMI group)were significantly higher than those in the control group(WBC:11.67±4.85×10^(9)/L vs.6.41±0.72×10^(9)/L,P<0.05;N:9.27±4.75×10^(9)/L vs.3.89±0.81×10^(9)/L,P<0.05),and WBCs were significantly associated with creatine kinase-myocardial band(CK-MB)on the first day(Y=8.945+0.018X,P<0.05).In addition,the T-AOC was significantly lower in the AMI group comparing to the control group(12.80±1.79 U/mL vs.20.48±2.55 U/mL,P<0.05).According to the gene analysis,eight up-regulated differentially expressed genes(DEGs)included GADD45A,PRDX2,HSPD1,DNAJB1,DNAJB2,RAD50,TNFSF6,and TRADD.Four down-regulated DEGs contained CCNG1,CAT,CYP1A1,and ATM.TNFSF6 and CYP1A1 were detected by polymerase chain reaction(PCR)to verify the expression at different time points,and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression.GO and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response(UPR)and apoptosis.CONCLUSIONS:WBCs,especially neutrophils,were the critical cells that mediating reperfusion injury.MIRI was regulated by various genes,including oxidative metabolic stress,heat shock,DNA damage and repair,and apoptosis-related genes.The underlying pathway may be associated with UPR and apoptosis,which may be the novel therapeutic target.展开更多
Background Acute myocardial infarction （AMI） is the most serious type of coronary heart disease. However, less than 30% of these patients have been treated effectively in China. Delayed treatment is a leading cause....Background Acute myocardial infarction （AMI） is the most serious type of coronary heart disease. However, less than 30% of these patients have been treated effectively in China. Delayed treatment is a leading cause. This study aimed to evaluate a new regional cooperative model for improving the first medical contact-to-device time and the therapeutic effects on AMI patients. Methods A retrospective analysis of 458 ST-elevation myocardial infarction （STEMI） patients was performed. Patients were divided into two groups in terms of before or after the model were implemented. First medical contact-to-device time （FMC2D）, Door to device time （D2D）, referral time, cardiac functions, mean cost, days of hospitalization, and major adverse cardiac events （MACE） were analyzed. Results The mean FMC2D time, D2D time and referral time of the model group were significantly lower than the control group. The left ventricular ejection fraction of the model group increased but the left ventricular end-diastolic dimension decreased compared with the control group at 6 months after discharge. These re- sults also showed that mean costs and days of hospitalization were reduced. The MACE rate was reduced in the model group. Conclusions These results suggested that the new model decreased the FMC2D time, which could improve the cardiac function and therapeutic effect of STEMI patients as well as decreased the financial burden.展开更多
AIM: To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction(STEMI).METHODS: An online literature search was ...AIM: To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction(STEMI).METHODS: An online literature search was performed in Pub Med and OVID® electronic databases to identify any studies that assessed global myocardial strain parameters using speckle-tracking echocardiography(STE) and/or cardiac magnetic resonance imaging(CMR) techniques [either myocardial tagging or feature tracking(FT) software] in an acute STEMI cohort(days 0-14 post-event) to predict prognosis [either development of major adverse cardiac events(MACE)] or adverse left ventricular(LV) remodelling at follow-up(≥ 6 mo for MACE,≥ 3 mo for remodelling). Search was restricted to studies within the last 20 years. All studies that matched the pre-defined search criteria were reviewed and their results interpreted. Due to considerable heterogeneity between studies,metaanalysis was not performed.RESULTS: A total of seven studies(n = 7) were identified that matched the search criteria. All studies used STE to evaluate strain parameters- five(n = 5) assessed global longitudinal strain(GLS)(n = 5),one assessed GLS rate(GLS-R)(n = 1) and one assessed both(n = 1). Three studies showed that GLS independently predicted the development of adverse LV remodelling by multivariate analysis- odds ratio between 1.19(CI: 1.04-1.37,P < 0.05) and 10(CI: 6.7-14,P < 0.001) depending on the study. Four studies showed that GLS predicted the development of MACE- hazard ratio(HR) between 1.1(CI: 1-1.1,P = 0.006) and 2.34(1.10-4.97,P < 0.05). One paper found that GLS-R could significantly predict MACEHR 18(10-35,P < 0.001)- whilst another showed it did not. GLS <-10.85% had sensitivity/specificity of 89.7%/91% respectively for predicting the development of remodelling whilst GLS <-13% could predict the development of MACE with sensitivity/specificity of 100%/89% respectively. No suitable studies were identified that assessed global strain by CMR tagging or FT techniques.CONCLUSION: GLS measured acutely post-STEMI by STE is a predictor of poor prognosis. Further research is needed to show that this is true for CMR-based techniques.展开更多
Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is ...Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service （EMS） STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties （Nassau, Camden and Charlton Counties） within a 50-mile radius of University of Florida Health-Jacksonville （UFHJ） from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements： （1） a cooperative agreement between each of the rural emergency medical service （EMS） agency and UFHJ; （2） performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and （3） direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device （FMC2D）, door-to-device （D2D）, and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio （OR） of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs （81 ± 17 vs. 87± 19 min）, but D2D times were similar （37 ± 18 vs. 39 ± 21 min）. FMC2D 〈 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs （OR = 4.4, 95% CI： 1.24-15.57; P = 0.018）. FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D 〈 120 min. Conclusions Guideline-compliant FMC2D ≤90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time 〈 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-ana...Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients' records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9%(82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6%(44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.展开更多
In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to rev...In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.展开更多
基金Project supported by the China Capital Clinical Research(No.Z121107001012002)
文摘Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.
基金Sanofi without any infl uence on the process,data collection,data management,and/or the editorial process.
文摘Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt.
文摘BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE.
文摘BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used STATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation(ECMO)(OR:3.10 P<0.05)in the LC group were associated with increased mortality.Early PCI(-2.57 P<0.05)and Impella(-3.25 P<0.05)were also both associated with shorter LOS compared to those who did not.Early ECMO does not impact the LOS;however,it does increase total hospital charge(addition of$24717.85,P<0.05).CONCLUSION LC is associated with a significantly increased inpatient mortality,length of stay,and total hospital charges in patients who develop SRCS.Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges.The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care.Patients with early PCI had both shorter LOS and reduced inpatient mortality,while early Impella was associated with increased mortality and shorter LOS.Early ECMO is associated with increased mortality and higher total hospital charges.This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization.
基金supported by Hospital-level Project of The Second Affiliated Hospital of Xi’an Medical College(No.16KY0116)。
文摘Identifying patients with high risk of death after myocardial infarction is a cornerstone of modern cardiovascular health care.The purpose of this study was to explore the predictive ability of N-terminal probrain natriuretic peptide(NT-pro-BNP)concentration and global acute coronary event register(GRACE)risk score in the prognosis of ST-segment elevation myocardial infarction(STEMI)patients,to find a better method for early risk stratification and prognosis judgment in the clinical diagnosis and treatment of STEMI patients,and to provide reliable clinical basis for making the best individualized treatment strategies for patients.Methods The final analysis included 118 confirmed STEMI patients who had received acute percutaneous coronary intervention(PCI).Thirty patients with STEMI were included in the major cardiac adverse events(MACEs)group,and the rest were included in the non-MACEs group.Multivariate Cox regression analysis was used to assess the relationship between the risk factors and MACEs.The receiver operator curves(ROC)were used to determine the area under the statistical curve(AUC).The linear correlation analysis confirmed the relationship between NT-proBNP concentration and GRACE score.Results After adjustment for sex,history of current smoking,hypertension,diabetes mellitus,cerebral artery disease and coronary artery vessel lesion(single-vessel lesion,2-vessel lesion,3-vessel lesion),onset time and medication,the multivariate Cox’s regression analysis showed that NT-proBNP concentration and GRACE score were the independent predictors for MACEs in STEMI patients who received PCI.Linear regression analysis showed that the level of NT-pro-BNP was positively correlated with GRACE score(r=0.612,P=0.000).The area under the curve(AUC)for GRACE,NT-pro-BNP and their combination were 0.757,0.723 and 0.782,respectively.Conclusions In a one-year follow-up,the concentration of NTpro-BNP and GRACE score were valuable of prediction for MACEs in STEMI patients who received PCI.In addition,NT-pro-BNP concentration was positively correlated with GRACE score.Additionally,the concentration of NT-pro-BNP could moderately enhance the GRACE score prediction of 1-year MACEs in STEMI patients who received PCI.
基金supported by Shenzhen Science and Technology Innovation Commission(No.JCYJ20180302150203732).
文摘Background Low diastolic blood pressure(DBP)was reported to be associated with reduced coronary blood flow,subclinical myocardial damage,and cardiovascular events. The aim of this study was to explore the impact of low DBP on clinical outcomes in patients with ST-elevation myocardial infarction(STEMI)undergoing percutaneous coronary intervention(PCI). Methods A total of 1232 patients with STEMI were retrospectively enrolled and divided into two groups according to admission DBP level:≥70 mm Hg(n=817)and < 70 mm Hg(n=415). The relationship between DBP and in-hospital and 1-year adverse events was evaluated.Results In-hospital death occurred in 2.4% of patients. The in-hospital mortality(5.3% vs. 1.0%,P<0.001)and major adverse clinical events(11.1% vs. 7.5%,P=0.033)were significantly higher in patients with a low DBP.DBP <70 mm Hg was associated with in-hospital death(adjusted odds rate=3.31,95%CI:1.36-8.07,P=0.009).Additional significant indicators included eGFR < 60 mL/min/1.73 m^2 and intra aorta balloon pump(IABP)treatment. Seventy-seven(6.3%)patients died in the one-year follow-up. DBP < 70 mm Hg was associated with increased risk of 1-year death(8.9% vs. 4.8%,Log-rank=9.9,P=0.002). Conclusion Low DBP was associated with increased risk of in-hospital and 1-year adverse prognosis in patients with STEMI undergoing PCI,which could be a tool for risk assessment.
文摘BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality.
文摘BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
文摘Timely reperfusion for patients with an ST-elevation myocardial infarction （STEMI） reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality.
基金supported by The Second Batch of Shantou Medical and Health Science and Technology Plan(self-financing)projects in 2019[shanfuke(2019)No.70]
文摘Background Corrected thrombolysis in myocardial infarction(TIMI)frame count(CTFC)was a simple and sensitive prognostic method that could reflect the perfusion status.Contemporary data on the relationship between CTFC and the prognosis for patients with ST-elevation myocardial infarction are not available.Methods Between January 2013 and December 2019,183 STEMI patients who attended in our center were retrospectively analyzed.All of the patients underwent primary percutaneous coronary intervention(PCI)and were with final TIMI grade 3 flow.Those patients were divided into high CTFC group(CTFC≥23 frames,n=76)and low CTFC group(CTFC<23 frames,n=107).The primary endpoint was the incidence of major adverse cardiovascular events(MACEs)after 12 months.Univariate and multivariate cox regression analysis was performed to figure out prognostic factors.Results A total of 183 individuals were included in this study.MACE rate was significantly higher in those patients with high CTFC(32.9%vs.15.7%,P=0.012),especially the revascularization rate(18.4%vs.2.8%,P=0.012).Multivariate Cox regression analysis showed that CTFC was the independent predictors of worse prognosis[risk ratio(RR):0.75,95%confidence interval(CI)0.67-0.82,P<0.001].Conclusions CTFC is feasible to identify the high-risk group after primary PCI for STEMI patients.High CTFC was associated with poor short-term clinical outcome.[S Chin J Cardiol 2021;22(1):7-12]
文摘Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term outcomes of ST-elevation myocardial infarction(STEMI) in patients undergoing primary percutaneous coronary intervention(PCI). The lymphocyte-to-monocyte ratio(LMR) is a novel inflammatory marker which is associated with slow coronary flow. We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI. Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018. Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon. Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure. The LMR level was significantly lower in patients with no-reflow(1.6 ±1.0 vs. 3.25 ± 1.8, P<0.001). Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356, 95% CI 1.201-5.945;P=0.030). The area under the ROC curve for the LMR was 0.757 [95% confidence interval(CI) 0.686-0.828, P<0.001]. Conclusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.[S Chin J Cardiol 2019;20(4):228-235]
基金supported by Science and Technology Planning Project of Guangdong Province (No.2017A070701013)。
文摘Background Despite receiving percutaneous coronary intervention(PCI),the mortality in elderly patients with ST-segment elevation myocardial infarction(STEMI)remains high.The aim of this study was to explore the prognostic value of neutrophil to platelet ratio(NPR)in elderly STEMI patients receiving PCI.Methods Patients≥65 years old with the diagnosis of STEMI who had received PCI was retrospectively enrolled between January 2010 and April 2016 in the Guangdong Provincial People's Hospital.The relationship between NPR and inhospital and 1-year mortality was evaluated.Results A total of 767 elderly patients with STEMI were included and divided into three groups according to the tertiles of NPR:<37(n=253),37-54(n=257),and≥54(n=257).Multivariate logistic regression analysis showed an independent correlation between elevated NPR and in-hospital death[odds ratio(OR)=1.02,95%confidential interval(CI):1.01-1.03,P<0.001].The receiver operating characteristic curve(AUC)analysis demonstrated a relatively high predictive value for NPR in identifying in-hospital death(AUC=0.765,95%CI:0.704-0.825,P<0.001,sensitivity=77.1%,specificity=69.0%,optimal cut-off value=54).As for 1-year mortality,multivariate Cox survival analysis revealed that NPR[hazard ratio(HR)=1.003,95%CI:1.001-1.004,P<0.001],as a continuous variable,and NPR>54(HR=2.70,95%CI 1.72-4.22,P<0.001),as a categorial variable,were both independent predictors for 1-year mortality.Conclusions NPR is a feasible predictor of poor prognosis for elderly patients with STEMI receiving PCI.
文摘Background The combination of glycoprotein Ⅱb/Ⅲ a inhibitors and heparin has not been compared with bivalirudin in studies specifically involving patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention （PCI）. We compared the two treatments in this patient population.
基金National Natural Science Foundation of China(81670220,31270992,and 30800215)Guangdong Provincial Natural Science Foundation(2014A030313086)+2 种基金Guangdong Provincial Science and Technology Plan Project(2015A020212013)Guangzhou Science and Technology Project(201804010007)This research was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University([2019]176).
文摘BACKGROUND:We aimed to investigate the gene expression of myocardial ischemia/reperfusion injury(MIRI)in patients with acute ST-elevation myocardial infarction(STEMI)using stress and toxicity pathway gene chip technology and try to determine the underlying mechanism.METHODS:The mononuclear cells were separated by ficoll centrifugation,and plasma total antioxidant capacity(T-AOC)was determined by the ferric reducing ability of plasma(FRAP)assay.The expression of toxic oxidative stress genes was determined and verified by oligo gene chip and quantitative real-time polymerase chain reaction(qRT-PCR).Additionally,gene ontology(GO)enrichment analysis was performed on DAVID website to analyze the potential mechanism further.RESULTS:The total numbers of white blood cells(WBC)and neutrophils(N)in the peripheral blood of STEMI patients(the AMI group)were significantly higher than those in the control group(WBC:11.67±4.85×10^(9)/L vs.6.41±0.72×10^(9)/L,P<0.05;N:9.27±4.75×10^(9)/L vs.3.89±0.81×10^(9)/L,P<0.05),and WBCs were significantly associated with creatine kinase-myocardial band(CK-MB)on the first day(Y=8.945+0.018X,P<0.05).In addition,the T-AOC was significantly lower in the AMI group comparing to the control group(12.80±1.79 U/mL vs.20.48±2.55 U/mL,P<0.05).According to the gene analysis,eight up-regulated differentially expressed genes(DEGs)included GADD45A,PRDX2,HSPD1,DNAJB1,DNAJB2,RAD50,TNFSF6,and TRADD.Four down-regulated DEGs contained CCNG1,CAT,CYP1A1,and ATM.TNFSF6 and CYP1A1 were detected by polymerase chain reaction(PCR)to verify the expression at different time points,and the results showed that TNFSF6 was up-regulated and CYP1A1 was down-regulated as the total expression.GO and kyoto encyclopedia of genes and genomes(KEGG)enrichment analysis suggested that the oxidative stress genes mediate MIRI via various ways such as unfolded protein response(UPR)and apoptosis.CONCLUSIONS:WBCs,especially neutrophils,were the critical cells that mediating reperfusion injury.MIRI was regulated by various genes,including oxidative metabolic stress,heat shock,DNA damage and repair,and apoptosis-related genes.The underlying pathway may be associated with UPR and apoptosis,which may be the novel therapeutic target.
文摘Background Acute myocardial infarction （AMI） is the most serious type of coronary heart disease. However, less than 30% of these patients have been treated effectively in China. Delayed treatment is a leading cause. This study aimed to evaluate a new regional cooperative model for improving the first medical contact-to-device time and the therapeutic effects on AMI patients. Methods A retrospective analysis of 458 ST-elevation myocardial infarction （STEMI） patients was performed. Patients were divided into two groups in terms of before or after the model were implemented. First medical contact-to-device time （FMC2D）, Door to device time （D2D）, referral time, cardiac functions, mean cost, days of hospitalization, and major adverse cardiac events （MACE） were analyzed. Results The mean FMC2D time, D2D time and referral time of the model group were significantly lower than the control group. The left ventricular ejection fraction of the model group increased but the left ventricular end-diastolic dimension decreased compared with the control group at 6 months after discharge. These re- sults also showed that mean costs and days of hospitalization were reduced. The MACE rate was reduced in the model group. Conclusions These results suggested that the new model decreased the FMC2D time, which could improve the cardiac function and therapeutic effect of STEMI patients as well as decreased the financial burden.
基金funded by the University of Leicester and the National Institute for Health Research (NIHR) in the United Kingdom
文摘AIM: To conduct a systematic review relating myocardial strain assessed by different imaging modalities for prognostication following ST-elevation myocardial infarction(STEMI).METHODS: An online literature search was performed in Pub Med and OVID® electronic databases to identify any studies that assessed global myocardial strain parameters using speckle-tracking echocardiography(STE) and/or cardiac magnetic resonance imaging(CMR) techniques [either myocardial tagging or feature tracking(FT) software] in an acute STEMI cohort(days 0-14 post-event) to predict prognosis [either development of major adverse cardiac events(MACE)] or adverse left ventricular(LV) remodelling at follow-up(≥ 6 mo for MACE,≥ 3 mo for remodelling). Search was restricted to studies within the last 20 years. All studies that matched the pre-defined search criteria were reviewed and their results interpreted. Due to considerable heterogeneity between studies,metaanalysis was not performed.RESULTS: A total of seven studies(n = 7) were identified that matched the search criteria. All studies used STE to evaluate strain parameters- five(n = 5) assessed global longitudinal strain(GLS)(n = 5),one assessed GLS rate(GLS-R)(n = 1) and one assessed both(n = 1). Three studies showed that GLS independently predicted the development of adverse LV remodelling by multivariate analysis- odds ratio between 1.19(CI: 1.04-1.37,P < 0.05) and 10(CI: 6.7-14,P < 0.001) depending on the study. Four studies showed that GLS predicted the development of MACE- hazard ratio(HR) between 1.1(CI: 1-1.1,P = 0.006) and 2.34(1.10-4.97,P < 0.05). One paper found that GLS-R could significantly predict MACEHR 18(10-35,P < 0.001)- whilst another showed it did not. GLS <-10.85% had sensitivity/specificity of 89.7%/91% respectively for predicting the development of remodelling whilst GLS <-13% could predict the development of MACE with sensitivity/specificity of 100%/89% respectively. No suitable studies were identified that assessed global strain by CMR tagging or FT techniques.CONCLUSION: GLS measured acutely post-STEMI by STE is a predictor of poor prognosis. Further research is needed to show that this is true for CMR-based techniques.
文摘Backgrounds ST-elevation myocardial infarction （STEMI） guidelines recommend reperfusion by primary percutaneous coronary in- tervention （PCI） ≤ 90 min from time of first medical contact （FMC）. This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service （EMS） STEMI field triage protocol. Methods Sixty STEMI patients directly transported by EMS from three rural counties （Nassau, Camden and Charlton Counties） within a 50-mile radius of University of Florida Health-Jacksonville （UFHJ） from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements： （1） a cooperative agreement between each of the rural emergency medical service （EMS） agency and UFHJ; （2） performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and （3） direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device （FMC2D）, door-to-device （D2D）, and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio （OR） of achieving FMC2D times was calculated. Results FMC2D times were shorter for in-state STEMIs （81 ± 17 vs. 87± 19 min）, but D2D times were similar （37 ± 18 vs. 39 ± 21 min）. FMC2D 〈 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs （OR = 4.4, 95% CI： 1.24-15.57; P = 0.018）. FMC2D times were homogenous after adjusting for weekday vs. weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D 〈 120 min. Conclusions Guideline-compliant FMC2D ≤90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground transportation. As all patients achieved a FMC2D time 〈 120 min, bypass of non-PCI capable hospitals may be reasonable in this situation.
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
文摘Objective: To investigate the relationship between serum C-reactive protein (CRP) level and left ventricular function in patients with acute ST-elevation myocardial infarction. Methods: This study is a descriptive-analytic study and was conducted on patients with ST-elevation myocardial infarction, who were admitted to the Urmia Hospital in Seyed Alshohada Hospital, and underwent primary percutaneous coronary intervention from October to March 2018. Demographic, angiographic, echocardiographic data were evaluated based on the patients' records. All patients were evaluated for 90 min and CRP levels were measured during the first 6 h after the primary percutaneous coronary intervention. Results: A total of 114 patients were studied, among whom 71.9%(82 patients) were male, and their mean age was (57.86±9.57) years old. The mean BMI was (26.1±3.8) kg/m2. Altogether 38.6%(44 patients) had a history of smoking, 17.5% (20 patients) of diabetes, 38.6% (44 patients) of hypertension, 5.3% (6 patients) of hyperlipidemia and 7.0% (8 patient) of coronary artery disease. The results showed a significantly negative correlation between ejection fraction and CRP, left atrial volume and CRP (P<0.05), and a significantly positive correlation between the global longitudinal strain level and CRP. The CRP level was significantly different at various diastolic grades (P=0.001). The level of CRP in patients with grade 2 diastolic dysfunction was higher than grade 1 diastolic dysfunction, while the level of CRP in diastolic grade 1 diastolic dysfunction was higher than the normal function. Conclusions: High CRP levels are associated with ejection fraction, global longitudinal strain loss and left atrial volume.
文摘In patients with ST-elevation myocardial infarction, recurrent cardiovascular events still remain the main cause of morbidity and mortality, despite significant improvements in antithrombotic therapy. We sought to review data regarding coronary thrombus analysis provided by studies using manual aspiration thrombectomy(AT), andto discuss how insights from this line of investigation could further improve management of acute coronary disease. Several studies investigated the fresh specimens retrieved by AT using techniques such as traditional morphological evaluation, optical microscopy, scanning electron microscopy, magnetic resonance imaging, and immunohistochemistry. These approaches have provided a better understanding of the composition and dynamics of the human coronary thrombosis process, as well as its relationship with some clinical outcomes. Recent data signaling to new antithrombotic therapeutic targets are still emerging.
