BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress...BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.展开更多
BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients ...BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.展开更多
It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study ai...It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.展开更多
AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to con...AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.展开更多
BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular ...BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.展开更多
Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction...Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.展开更多
Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-qua...Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.展开更多
Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifes...Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.展开更多
Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods...Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods:A total of 111 patients with acute myocardial infarction(AMI)who received interventional therapy in Department of Cardiology of Hefei First People’s Hospital from January 2022 to September 2023 were selected as the study subjects.They were randomly divided into a control group(n=55)and a study group(n=56)using a random table method.Both groups received routine nursing care,while the control group received exercise training on top of it.The study group received narrative nursing care on top of the control group.Both groups were intervened until the patients were discharged.The health beliefs,heart function,psychological status,and quality of life after intervention were compared between two groups using a 6-minute walk test(6MWT).Results:After intervention,the scores of the TSK-SV Heart in all dimensions(fear of movement,functional disorders,risk perception,and avoidance of movement)decreased in both groups,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,the scores of the Self Rating Anxiety Scale(SAS)and Self Rating Depression Scale(SDS)in both groups decreased,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,both groups showed an increase in left ventricular ejection fraction(LVEF)and left ventricular early diastolic peak flow velocity/left ventricular late diastolic peak flow velocity(E/A),with the study group being higher than the control group.The left ventricular end diastolic diameter(LVEDD)and left atrial volume index(LAVI)decreased,and the study group was lower than the control group,with statistical significant differences(P<0.05).The walking distance of the study group at 6MWT(488.8±31.4)m was greater than that of the control group(425.54±30.7)m,with statistical significant differences(P<0.05).The quality of life measurement scale(CROQ-PTCA-Post)of the study group after coronary intervention treatment had higher scores in all dimensions(physical function,satisfaction,psychosocial function,adverse reactions,symptoms,cognitive function)than the control group,with statistical significant differences(P<0.05).Conclusion:Narrative nursing combined with exercise training can enhance the health beliefs of AMI patients towards exercise training after intervention therapy,which is beneficial for cardiac rehabilitation and can improve psychological status and quality of life.展开更多
Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes signif...Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.展开更多
Acute myocardial infarction(AMI)remains a leading global cause of morbidity and mortality,with high risk of recurrent adverse cardiovascular events.Conventional diagnostic markers often lack the sensitivity needed for...Acute myocardial infarction(AMI)remains a leading global cause of morbidity and mortality,with high risk of recurrent adverse cardiovascular events.Conventional diagnostic markers often lack the sensitivity needed for early detection and prognostic stratification.Recent advances highlight the role of microRNAs(miRNAs)and their genetic polymorphisms in regulating inflammation,fibrosis,and endothelial function in atherosclerotic disease.This review summarizes evidence on circulating miRNA expression and miRNA-related single nucleotide polymorphisms as biomarkers in AMI.Literature from PubMed,Scopus,and Web of Science was evaluated,focusing on pathways involving NF-κB,interleukin-1 receptor/toll-like receptors,and JAK/STAT signaling.Circulating miRNAs such as miR-150,miR-208,miR-26a,and miR-483-5p demonstrate strong diagnostic accuracy,while polymorphisms,particularly rs2910164 in miR-146a,are consistently associated with AMI susceptibility and adverse outcomes.These findings suggest that miRNAs and their variants may serve as non-invasive tools for diagnosis and risk prediction,supporting future integration into precision cardiovascular medicine.展开更多
This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,e...This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.展开更多
A mortality prediction model based on small acute myocardial infarction(AMI)patients coherent with low death rate is established.In total,1639 AMI patients are selected as research objects who received treatment in se...A mortality prediction model based on small acute myocardial infarction(AMI)patients coherent with low death rate is established.In total,1639 AMI patients are selected as research objects who received treatment in seven tertiary and secondary hospitals in Shanghai between January 1,2016 and January 1,2018.Among them,72 patients deceased during the two-year follow-up.Models are established with ensemble learning framework and machine learning algorithms based on 51 physiological indicators of the patient.Shapley additive explanations algorithm and univariate test with point-biserial and phi correlation coefficients are employed to determine significant features and rank feature importance.Based on 5-fold cross validation experiment and external validation,prediction model with self-paced ensemble framework and random forest algorithm achieves the best performance with area under receiver operating characteristic curve(AUROC)score of 0.911 and recall of 0.864.Both feature ranking methods showed that ejection fractions,serum creatinine(admission),hemoglobin and Killip class are the most important features.With these top-ranked features,the simplified prediction model is capable of achieving a comparable result with AUROC score of 0.872 and recall of 0.818.This work proposes a new method to establish mortality prediction models for AMI patients based on self-paced ensemble framework,which allows models to achieve high performance with small scale of patients coherent with low death rate.It will assist in medical decision and prognosis as a new reference.展开更多
BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the p...BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the popularization of percutaneous coronary intervention.However,the risk is significantly increased for those who fail to undergo revascularization in time,and the mortality rate remains high.The current core contradiction in clinical practice lies in the selection of surgical timing,and the disparity in medical resources significantly affects prognosis.There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.AIM To investigate the clinical features,determine the prognostic factors,and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture(AMI-VSR)residing in high-altitude regions.METHODS This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024,with the establishment of survival(n=30)and mortality(n=18)groups based on patients’survival status.Risk factors were identified by univariate and multivariate logistic regression analyses.A nomogram model was developed using R software and validated via receiver operating characteristic(ROC)analysis and calibration curves.RESULTS Age,uric acid(UA),interleukin-6(IL-6),and low hemoglobin(Hb)were independent risk factors for 30-day mortality(odds ratios:1.147,1.006,1.034,and 0.941,respectively;P<0.05).The nomogram demonstrated excellent discrimination(area under the ROC curve=0.939)and calibration(Hosmer-Lemeshowχ²=2.268,P=0.971).In addition,patients’poor outcomes could be synergistically predicted by IL-6 and UA,advanced age,and reduced Hb.CONCLUSION This study highlights age,UA,IL-6,and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes.The validated nomogram provides a practical tool for early risk stratification and tailored interventions,addressing gaps in managing this high-risk population in resource-limited settings.展开更多
Objective To evaluate short time effects of primary percutaneous coronary intervention (pPCI) and rtPA thrombolysis+PCI (rtPA+PCI) on myocardial viability and ventricular systolic synchrony in AMI patients.Methods Eig...Objective To evaluate short time effects of primary percutaneous coronary intervention (pPCI) and rtPA thrombolysis+PCI (rtPA+PCI) on myocardial viability and ventricular systolic synchrony in AMI patients.Methods Eighty seven patients with first AMI were divided into two groups: group A ( n =42), pPCI group, the patients underwent PCI within 6h after onset of AMI; group B ( n =45), rtPA+PCI group, the patients underwent PCI after thrombolysis within 6h after onset of AMI; Myocardial viability was measured by 99m Tc MIBI SPECT. While, the parameters of cardiac function LVEF and ventricular systolic synchrony LVPS were measured by 99m Tc gated cardiac blood pool image on the first and the fourth weekend. Results (1) The peak CK MB was significantly lower in group A than that in group B( P <0.01 ). (2) Myocardial infarction area (MIA) was decreased and radioactivity counts in MIA was significantly increased in group A and B on the 4th weekend compared with that on the first weekend ( P <0.01 ), but there were no significant difference between group A and group B. (3) LVEF, LVPS were no significant difference between group A and group B.Conclusions (1)pPCI in acute myocardial infartion can limit infarct area, maintain ventricular systolic synchrony and improve ventricular function; (2) but, in those hospitals that there were no any condition for PCI, they should transfer the patients to central hospital for PCI after thrombolysis at the first time. It is beneficial to improve myocardial viability and ventricular systolic synchrony of AMI patients in short time.展开更多
Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(...Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.展开更多
Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients re...Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.展开更多
Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response...Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Iuflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction （AMI）, Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes （such as death, recurrent myocardial in- farction, and heart failure） in patients with AMI.展开更多
Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is...Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.展开更多
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleed...Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.展开更多
基金supported by the National Natural Science Foundation of China(No.62135002)the Key Research and Development Program of Heilongjiang Province(No.2022ZX01A28).
文摘BACKGROUND Acute myocardial infarction(AMI)is a major cause of mortality worldwide.The stress hyperglycemia ratio(SHR),which integrates glucose and glycated hemoglobin A1c levels,better reflects acute metabolic stress.This study assessed the SHR and longterm prognosis of patients with AMI.METHODS This study was a post-hoc analysis based on the prospective,multicenter OPTIMAL registry(http://www.clinicaltrials.gov,NCT number:NCT03084991).A total of 3384 consecutive patients who underwent percutaneous coronary intervention(PCI)at Department of Cardiology,The 2nd Affiliated Hospital of Harbin Medical University,Harbin,China were included in the present analysis after exclusions.Patients were stratified into quartiles according to the SHR.The primary endpoint was cardiovascular death,with all-cause death and major adverse cardiovascular events as secondary endpoints.The median follow-up duration was 24.1 months,with a completion rate of 99.5%.RESULTS Kaplan-Meier survival curves showed progressively worse survival across SHR quartiles(log-rank P<0.001),with patients in Q4(SHR≥1.34)experiencing the highest risk.Multivariate Cox regression analysis confirmed that the SHR was an independent predictor of cardiovascular death[hazard ratio(HR)=1.56],all-cause death(HR=1.48),and major adverse cardiovascular events(HR=1.34)for Q4(SHR≥1.34)versus Q2(SHR:0.93–1.11).Restricted cubic spline analysis revealed a J-shaped association between SHR and outcomes,with the lowest risk observed at an SHR of approximately 1.0.CONCLUSIONS The SHR is an independent predictor of long-term adverse outcomes in patients with AMI undergoing PCI,supporting its use for early risk stratification and glycemic management.
文摘BACKGROUND Acute myocardial infarction(AMI)is rare among patients aged≤40 years but imposes significant morbidity,psychological distress,and economic burden.App-roximately 10%of AMI hospitalizations involve patients under 45 years,under-scoring the need to study this group.Compared to older patients,young AMI pa-tients exhibit fewer traditional risk factors(e.g.,hypertension,diabetes)but higher rates of smoking,obesity,and non-atherosclerotic causes like spontaneous coro-nary artery dissection or coronary spasm,often linked to substance use.Global trends show rising obesity and dyslipidemia in young populations,with smoking contributing to 62%–90%of AMI cases in this age group.Family history of coro-nary artery disease also elevates risk,particularly in acute coronary syndrome.Studies like Bhardwaj et al report that young AMI patients are predominantly male with single-vessel disease,unlike the multi-vessel disease typical in older cohorts.This study characterizes AMI in young adults(≤40 years)at a single center,focusing on presentation,risk factors,angiographic findings,and manage-ment to guide preventive strategies.AIM To describe the characteristics of AMI in young patients,including presentation,risk factors,coronary angiography(CAG)findings,and management strategies.METHODS This retrospective cross-sectional study analyzed 91 patients aged 20–40 years diagnosed with AMI at Mouwasat Hospital Dammam,from June 2020 to May 2023.Data on clinical presentation,cardiovascular risk factors,CAG findings,and treatments were collected from medical records.Descriptive statistics were used to summarize findings.RESULTS Of 91 patients(96.7%male,mean age 35.9 years±3.4 years),43.9%were obese(body mass index>30 kg/m^(2)).Hyperlipidemia was the most prevalent risk factor(69.2%),followed by smoking(49.5%),diabetes mellitus(33.0%),and hypertension(26.4%).ST-elevation myocardial infarction(STEMI)was the most common presentation(57.1%).The left anterior descending artery was frequently affected(78.0%),with single-vessel disease predominant(72.5%).Most patients underwent percutaneous coronary intervention(PCI)(74.7%),while 8.8%required surgery.CONCLUSION Young AMI patients are predominantly obese males with hyperlipidemia and smoking as key risk factors,pre-senting with STEMI and single-vessel disease amenable to PCI.
基金funded in part by the National Key R&D Program of China(Grant No.2022YFC2402404)the National Natural Science Foundation of China(Grant Nos.82170351 and 82370342)+1 种基金the Natural Science Foundation of Jiangsu Province(Grant Nos.BK20222002 and BK20231145)the Clinical Capacity Enhancement Project of Jiangsu Province Hospital(the First Affiliated Hospital of Nanjing Medical University)(Grant No.J SPH-MA-2022-3)。
文摘It is often challenging to diagnose acute myocardial infarction(AMI)in patients with elevated high-sensitivity cardiac troponin T(hs-cTnT)before observing a significant rise and/or fall in hs-cTnT.The current study aimed to identify an optimal cut-off to rule in AMI.A total of 76411 patients with elevated hs-cTnT were included.The predictive cut-off values for diagnosing ST-segment elevation myocardial infarction(STEMI)and non-STsegment elevation myocardial infarction(NSTEMI)were assessed using the area under the receiver operating characteristic curve(AUC).Among the patients,50466(66.0%)had non-cardiac diseases,25945(34.0%)had cardiac diseases,and 15502(20.3%)had AMI,including 816(1.1%)with STEMI and 14686(19.2%)with NSTEMI.The median hs-cTnT level was 3788.0 ng/L in STEMI patients and 67.2 ng/L in NSTEMI patients.The optimal cut-off for diagnosing STEMI was 251.9 ng/L,with a sensitivity of 90.7%,specificity of 86.5%,and an AUC of 0.942;the optimal cut-off for diagnosing NSTEMI was 130.5 ng/L,with a sensitivity of 40.9%,specificity of 83.8%,and an AUC of 0.638.Collectively,optimizing the cut-off values for diagnosing STEMI and NSTEMI to 251.9 ng/L and 130.5 ng/L,respectively,demonstrated high accuracy in a large cohort of Chinese patients with elevated hs-cTnT.
基金Supported by Guangdong Medical Research Foundation(No.A2024382)Guangdong Provincial Bureau of Traditional Chinese Medicine research project(No.20231321)Scientific Research Start Plan of Shunde Hospital,Southern Medical University(No.SRSP2022012,No.SRSP2022016)。
文摘AIM:To investigate whether melatonin can ameliorate acute myocardial infarction(AMI)by in⁃hibiting ferroptosis.METHODS:H9C2 cells were cultured in AnaeroPack system with low sugar and serum-free medium for 10 h to construct a cell model of AMI.Then cells were treated with melatonin and ferroptosis inducer erastin.The cell activity,reactive oxygen species(ROS),lipid peroxidation,mitochondrial membrane potential(MMP),and ferroptosis related protein expression were detected.A rat model of AMI induced by isoprenaline(ISO)injection was established to evaluate the effects of melatonin,in which the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,iron ion and ferroptosis related protein expression were examined.RESULTS:Melatonin decreased the oxidative stress,lipid peroxidation and expression of ferroptosis protein in cardiomyocytes induced by hypoxia,but these effects could be impeded by the ferroptosis inducer erastin.Furthermore,in vivo experiments,we also found that melatonin im⁃proved the myocardial infarction size,cardiac injury,pathological changes,oxidative stress,and alleviated iron ion accu⁃mulation and ferroptosis.CONCLUSION:The cardioprotective effects of melatonin in AMI are associated with the inhi⁃bition of ferroptosis.
基金supported by the Tianjin Key Medical Discipline(Specialty)Construction Project(TJYXZDXK-029A)the Key Project of Tianjin Natural Science Foundation(21JCZDJC01080)the Tianjin Fourth Central Hospital Outstanding Young Talent Fund(tjdszxyy20230008).
文摘BACKGROUND Heart failure with preserved ejection fraction(HFpEF)following acute myocardial infarction(AMI)carries substantial morbidity and mortality,yet reliable prognostic markers beyond conventional cardiovascular factors remain limited.Frailty,reflecting diminished physiological reserve,has emerged as a potential determinant of adverse outcomes in this high-risk population.Therefore,the aim of this study was to address a critical knowledge gap and to provide evidence that may guide frailty-adapted management strategies to improve prognosis and quality of life in this high-risk population.METHODS We conducted a multicenter retrospective cohort study including 4507 patients with HFpEF discharged after AMI across 82 hospitals in China(from January 2010 to March 2024).Frailty was assessed using the Hospital Frailty Risk Score(HFRS),with HFRS<5 defined as non-frail and HFRS≥5 as frail.Multivariable Cox proportional hazards models,adjusted for demographics,comorbidities,left ventricular ejection fraction,and therapies,were applied to evaluate associations between frailty and clinical outcomes.The primary endpoints were all-cause death and major adverse cardiovascular events(MACE),which defined as the composite of cardiovascular death and heart failure rehospitalization.Secondary endpoints included net adverse clinical events(NACE),which defined as the composite of all-cause death,stroke,recurrent myocardial infarction,revascularization,and major bleeding,as well as the individual components of MACE.RESULTS Frailty was independently associated with a higher risk of all-cause death[adjusted hazard ratio(aHR)=1.52,95%CI:1.31–2.03,P=0.005]and NACE(aHR=1.20,95%CI:1.02–1.41,P=0.026).At one year,frail patients had higher unadjusted rates of all-cause death(9.0%vs.2.9%)and NACE(19.8%vs.13.7%)compared with non-frail patients.For cardiovascular death,the association did not reach statistical significance(aHR=1.42,95%CI:0.99–2.03,P=0.053).No significant associations were found for MACE(aHR=1.05,95%CI:0.86–1.28,P=0.636)or heart failure rehospitalization(aHR=0.94,95%CI:0.75–1.19,P=0.616).CONCLUSIONS Frailty,as measured by the HFRS,is an independent predictor of one-year mortality and composite adverse events in post-AMI HFpEF patients.These findings support the use of HFRS at discharge to identify high-risk population who may benefit from closer follow-up,optimization of medical therapy,and targeted frailty-focused interventions.
基金supported by the Natural Science Foundation of Shandong Province(ZR2021QH096,ZR2020MH024)the National Natural Science Foundation of China(82300354,882070345)+2 种基金the Academic Promotion Program of Shandong First Medical University(2019QL012)the Shandong Taishan Scholarship(to SHY)fund of Tianjin Zhongxin Pharmaceutical Group Co.,Ltd。
文摘Acute myocardial infarction(AMI)is a leading cause of death and disability worldwide and consists of two distinct cardiac pathologies:ST-elevation myocardial infarction(STEMI)and non-ST-elevation myocardial infarction(NSTEMI).[1]In China,AMI is widely recognized as a predominant cause of mortality in both urban and rural demographics,based on the 2022 Report on Cardiovascular Health and Diseases in China;moreover,its mortality rate has been reported to be rising,with a recurrence rate of 2.5%within one year.
文摘Acute myocardial infarction(AMI)is characterized by myocardial necrosis resulting from acute coronary circulatory insufficiency.In cases progressing to cardiac arrest,two interventions are important:sustained high-quality cardiopulmonary resuscitation(CPR)and prompt coronary reperfusion to minimize irreversible myocardial damage.With advances in emergency medical care,both emergency thrombolysis and extracorporeal cardiopulmonary resuscitation(ECPR)are utilized,even in prehospital treatment,thereby extending the golden window for rescuing such patients.
文摘Anxiety disorders following percutaneous coronary intervention for acute myocardial infarction affect approximately 20%-40%of patients,with a significantly greater prevalence in females(OR=1.8).These disorders manifest through physiological symptoms,cognitive distortions,behavioral avoidance,and cardiacspecific concerns and typically emerge within 1-2 weeks post-procedure.Key risk factors include female sex,younger age(<55 years),psychiatric history,procedural complexity,and poor social support.Anxiety negatively affects cardiovascular outcomes when left untreated,leading to higher readmission rates(HR=1.47)and recurrent cardiovascular events(HR=1.31),as well as lower medication adherence and quality of life.Screening is optimally conducted 7-10 days postprocedure via validated tools such as the Hospital Anxiety and Depr-ession Scale,Anxiety.Heart-specific cognitive behavioral therapy(SMD=-0.72),selective serotonin reuptake inhibitors(especially sertraline),and integrated cardiac rehabilitation programs that incorporate both psychological and physical elements are among the beneficial interventions that have been supported by evidence.These all-encompassing strategies show long-term improvements in cardiovascular outcomes,functional ability,and healthcare expenses in addition to immediate benefits in lowering anxiety.Digital initiatives have the potential to increase access,especially in underprivileged areas.Early identification of highrisk patients and implementation of timely,targeted interventions represent crucial strategies for improving both psychological and cardiovascular outcomes in this vulnerable population.
文摘Objective:To explore the effect of narrative nursing combined with exercise training on health beliefs and cardiac rehabilitation in patients with acute myocardial infarction(AMI)after interventional treatment.Methods:A total of 111 patients with acute myocardial infarction(AMI)who received interventional therapy in Department of Cardiology of Hefei First People’s Hospital from January 2022 to September 2023 were selected as the study subjects.They were randomly divided into a control group(n=55)and a study group(n=56)using a random table method.Both groups received routine nursing care,while the control group received exercise training on top of it.The study group received narrative nursing care on top of the control group.Both groups were intervened until the patients were discharged.The health beliefs,heart function,psychological status,and quality of life after intervention were compared between two groups using a 6-minute walk test(6MWT).Results:After intervention,the scores of the TSK-SV Heart in all dimensions(fear of movement,functional disorders,risk perception,and avoidance of movement)decreased in both groups,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,the scores of the Self Rating Anxiety Scale(SAS)and Self Rating Depression Scale(SDS)in both groups decreased,and the study group was lower than the control group,with a statistical significant difference(P<0.05).After intervention,both groups showed an increase in left ventricular ejection fraction(LVEF)and left ventricular early diastolic peak flow velocity/left ventricular late diastolic peak flow velocity(E/A),with the study group being higher than the control group.The left ventricular end diastolic diameter(LVEDD)and left atrial volume index(LAVI)decreased,and the study group was lower than the control group,with statistical significant differences(P<0.05).The walking distance of the study group at 6MWT(488.8±31.4)m was greater than that of the control group(425.54±30.7)m,with statistical significant differences(P<0.05).The quality of life measurement scale(CROQ-PTCA-Post)of the study group after coronary intervention treatment had higher scores in all dimensions(physical function,satisfaction,psychosocial function,adverse reactions,symptoms,cognitive function)than the control group,with statistical significant differences(P<0.05).Conclusion:Narrative nursing combined with exercise training can enhance the health beliefs of AMI patients towards exercise training after intervention therapy,which is beneficial for cardiac rehabilitation and can improve psychological status and quality of life.
文摘Background Acute Myocardial Infarction(AMI)is a critical and commonly encountered condition in the field of cardiovascular medicine.When AMI is complicated by cardiogenic shock(CS),the clinical scenario becomes significantly more complex and perilous,with a marked increase in patient mortality.Currently,traditional thera-peutic approaches such as intra-aortic balloon pumping(IABP)have demonstrated efficacy in improving myocardi-al perfusion and hemodynamics.However,the supportive capacity of IABP is limited in patients with severe heart failure.In recent years,extracorporeal membrane oxygenation(ECMO),as an advanced extracorporeal circulatory support technology,has been increasingly utilized in clinical practice,offering a novel therapeutic option for pa-tients with severe heart failure.This study aimed to investigate the clinical efficacy of combining IABP and ECMO in patients with AMI complicated by CS,evaluating its impact on myocardial injury,hemodynamic stability,and clinical outcomes.Methods This study retrospectively analyzed the clinical data of 52 patients with AMI compli-cated by CS admitted to our hospital between May 2023 and May 2024.Based on the treatment methods,the pa-tients were divided into an ECMO group(n=26)and a non-ECMO group(n=26).Post-treatment comparisons were made between the two groups regarding myocardial injury markers such as cardiac troponin I,lactate,and creatine kinase-MB,hemodynamic parameters such as mean arterial pressure,cardiac output,and central venous pressure,and the incidence of complications such as acute kidney injury,bleeding,infection.The primary endpoint of this study was the post-treatment mortality rate and the incidence of complications.Secondary endpoints included changes in myocardial injury markers[cardiac troponin I(cTnI),lactic acid(LAC),creatine kinase isoenzymes(CK-MB)]and improvements in hemodynamic parameters[mean arterial pressure(MAP),cardiac output(CO),central venous pressure(CVP)].The results of multivariate regression analyses were used to explore the incidence of EC-MO complications.Results After treatment,the levels of myocardial injury markers such as cTnI,LAC,and CK-MB in ECMO group were significantly lower than non-ECMO group(P<0.05);MAP and CO in ECMO group were significantly higher than non-ECMO group,while CVP was significantly lower(P<0.05);the mortality rate and the incidence of complications in ECMO group were lower than non-ECMO group(P<0.05).Further multivariate re-gression analysis showed that age,smoking,hyperlipidaemia and diabetes could affect the incidence of ECMO complications(P<0.05).Conclusions The combined use of IABP and ECMO exhibits substantial therapeutic benefits,including the mitigation of myocardial injury,enhancement of hemodynamic stability,and improvement in clinical prognosis among patients with AMI complicated by CS.Clinicians applying ECMO therapy should pay particular attention to older patients or those with concomitant diabetes mellitus or hyperlipidemia,as they might re-quire more intensive monitoring and prophylactic measures to mitigate the occurrence of complications.
文摘Acute myocardial infarction(AMI)remains a leading global cause of morbidity and mortality,with high risk of recurrent adverse cardiovascular events.Conventional diagnostic markers often lack the sensitivity needed for early detection and prognostic stratification.Recent advances highlight the role of microRNAs(miRNAs)and their genetic polymorphisms in regulating inflammation,fibrosis,and endothelial function in atherosclerotic disease.This review summarizes evidence on circulating miRNA expression and miRNA-related single nucleotide polymorphisms as biomarkers in AMI.Literature from PubMed,Scopus,and Web of Science was evaluated,focusing on pathways involving NF-κB,interleukin-1 receptor/toll-like receptors,and JAK/STAT signaling.Circulating miRNAs such as miR-150,miR-208,miR-26a,and miR-483-5p demonstrate strong diagnostic accuracy,while polymorphisms,particularly rs2910164 in miR-146a,are consistently associated with AMI susceptibility and adverse outcomes.These findings suggest that miRNAs and their variants may serve as non-invasive tools for diagnosis and risk prediction,supporting future integration into precision cardiovascular medicine.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,China,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project—Major Science and Technology Special Projects,No.202405AJ310003.
文摘This review comprehensively examines acute myocardial infarction with ventricular septal rupture(VSR),a rare yet lethal complication.We analyze its epidemiological,pathophysiological,clinical,and therapeutic aspects,emphasizing innovative strategies like bioabsorbable occluders and tissue engineering to reduce complications and improve prognosis.The integration of artificial intelligence and big data analytics for treatment decision-making and personalized surgical timing models is highlighted as transformative.Our analysis underscores the need for early diagnosis and tailored interventions,proposing future research directions in molecular mechanisms,multidisciplinary collaboration,and technology integration.These innovations promise to enhance VSR management and extend to other cardiovascular diseases,heralding a new era of precision and regenerative cardiovascular medicine.
基金the National Natural Science Foundation of China(No.81900308)。
文摘A mortality prediction model based on small acute myocardial infarction(AMI)patients coherent with low death rate is established.In total,1639 AMI patients are selected as research objects who received treatment in seven tertiary and secondary hospitals in Shanghai between January 1,2016 and January 1,2018.Among them,72 patients deceased during the two-year follow-up.Models are established with ensemble learning framework and machine learning algorithms based on 51 physiological indicators of the patient.Shapley additive explanations algorithm and univariate test with point-biserial and phi correlation coefficients are employed to determine significant features and rank feature importance.Based on 5-fold cross validation experiment and external validation,prediction model with self-paced ensemble framework and random forest algorithm achieves the best performance with area under receiver operating characteristic curve(AUROC)score of 0.911 and recall of 0.864.Both feature ranking methods showed that ejection fractions,serum creatinine(admission),hemoglobin and Killip class are the most important features.With these top-ranked features,the simplified prediction model is capable of achieving a comparable result with AUROC score of 0.872 and recall of 0.818.This work proposes a new method to establish mortality prediction models for AMI patients based on self-paced ensemble framework,which allows models to achieve high performance with small scale of patients coherent with low death rate.It will assist in medical decision and prognosis as a new reference.
基金Supported by Science and Technology Department of Yunnan Province-Kunming Medical University,Kunming Medical Joint Special Project-Surface Project,No.202401AY070001-164Yunnan Provincial Department of Science and Technology Science and Technology Plan Project-Major Science and Technology Special Projects,No.202405AJ310003+1 种基金Yunnan Provincial Department of Science and Technology Science and Technology Plan Project-Key Research and Development Program,No.202103AC100004Yunnan Province Science and Technology Department Key Research and Development Plan,No.202103AC100002.
文摘BACKGROUND Acute myocardial infarction(AMI)combined with ventricular septal perforation(VSR)is still a highly fatal condition in the era of reperfusion therapy.The incidence rate has decreased to 0.2%-0.4%due to the popularization of percutaneous coronary intervention.However,the risk is significantly increased for those who fail to undergo revascularization in time,and the mortality rate remains high.The current core contradiction in clinical practice lies in the selection of surgical timing,and the disparity in medical resources significantly affects prognosis.There is an urgent need to optimize the identification of high-risk populations and individualized treatment strategies.AIM To investigate the clinical features,determine the prognostic factors,and develop a predictive model for 30-day mortality in patients with acute myocardial infarction complicated by ventricular septal rupture(AMI-VSR)residing in high-altitude regions.METHODS This study retrospectively analyzed 48 AMI-VSR patients admitted to a Yunnan hospital from 2017 to 2024,with the establishment of survival(n=30)and mortality(n=18)groups based on patients’survival status.Risk factors were identified by univariate and multivariate logistic regression analyses.A nomogram model was developed using R software and validated via receiver operating characteristic(ROC)analysis and calibration curves.RESULTS Age,uric acid(UA),interleukin-6(IL-6),and low hemoglobin(Hb)were independent risk factors for 30-day mortality(odds ratios:1.147,1.006,1.034,and 0.941,respectively;P<0.05).The nomogram demonstrated excellent discrimination(area under the ROC curve=0.939)and calibration(Hosmer-Lemeshowχ²=2.268,P=0.971).In addition,patients’poor outcomes could be synergistically predicted by IL-6 and UA,advanced age,and reduced Hb.CONCLUSION This study highlights age,UA,IL-6,and Hb as critical predictors of mortality in AMI-VSR patients at high altitudes.The validated nomogram provides a practical tool for early risk stratification and tailored interventions,addressing gaps in managing this high-risk population in resource-limited settings.
文摘Objective To evaluate short time effects of primary percutaneous coronary intervention (pPCI) and rtPA thrombolysis+PCI (rtPA+PCI) on myocardial viability and ventricular systolic synchrony in AMI patients.Methods Eighty seven patients with first AMI were divided into two groups: group A ( n =42), pPCI group, the patients underwent PCI within 6h after onset of AMI; group B ( n =45), rtPA+PCI group, the patients underwent PCI after thrombolysis within 6h after onset of AMI; Myocardial viability was measured by 99m Tc MIBI SPECT. While, the parameters of cardiac function LVEF and ventricular systolic synchrony LVPS were measured by 99m Tc gated cardiac blood pool image on the first and the fourth weekend. Results (1) The peak CK MB was significantly lower in group A than that in group B( P <0.01 ). (2) Myocardial infarction area (MIA) was decreased and radioactivity counts in MIA was significantly increased in group A and B on the 4th weekend compared with that on the first weekend ( P <0.01 ), but there were no significant difference between group A and group B. (3) LVEF, LVPS were no significant difference between group A and group B.Conclusions (1)pPCI in acute myocardial infartion can limit infarct area, maintain ventricular systolic synchrony and improve ventricular function; (2) but, in those hospitals that there were no any condition for PCI, they should transfer the patients to central hospital for PCI after thrombolysis at the first time. It is beneficial to improve myocardial viability and ventricular systolic synchrony of AMI patients in short time.
文摘Objective Comparative study on the feasibility,safety and outcome of transradial artery and transfemoral artery access for primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction(AMI).Methods Two hundred and eight patients with AMI episoded within 12 hours, male 159, female 49, age 58.9 ±11.9 (34～88)years, were randomly divided into transradial artery access for primary PCI (TRA pPCI) group of 106 cases and transfemoral artery access for PCI (TFA pPCI) group of 102 cases during Sept, 2000 to Aug, 2002. The protocols of the manipulation duration and the effect for TRA pPCI and TFA pPCI procedures were respectively compared, including the time of transradial artery puncture and the rate of puncture success at first time ; the time of guiding catheter engaging into target coronary ostium; the rate of patence in infarct related artery (IRA); total duration of manipulation and the successful rate.The incidence of complications such as bleeding, vessel injury,thrombi and embolism as well as the average stay of hospitalization between two groups was compared. The status and the incidance of vessel spasm were observed and the effect of medicine administration to prevent from and relieve the vascular spasm was evaluated. The time of Allen’s test before and after TRA pPCI , the inner diameter and the peak of blood velocity of the right and left radial artery were investigated with color Doppler vessel echography as well as the complications of radial artery were followed up 1 month after TRA pPCI procedure. Results Two cases in every TRA pPCI and TFA pPCI groups were crossed over each other because procedure of the transradial or transfemoral access was failure. One handred and six vessels (48 vessels in LAD,22 vessels in LCX and 36 vessels in RCA) associated with 28 vessels of total occlusion in TRA pPCI group and 102 vessels (51 vessels in LAD,18 veesles in LCX and 33 vessels in RCA) with 24 vessels in total occlusion in TFA pPCI group were angioplasticized . The successful rates of the first time puncture in access artery, the re patence IRA and pPCI were similar in TRA pPCI and TFA pPCI groups ( 93.4% vs 96.1% ;100% vs 100%; 96.2% vs 97.1% , P >0.05 ). There were no significant diffierence in the average time of puncture time of access artery ,engaging in target vessels of guiding catheters and the total procedure of PCI between the two groups ( 1.3 ±0.3s vs 1.2 ±0.3s ; 6.0 ±1.6min vs 5.8 ±0.9min ; 49.2 ±24.1min vs 46.5 ± 26.4min , P >0.05 ). The access artery complications such as bleeding ,hematoma and embolism as well the veneous thrombosis in TFA pPCI group were much more than those in TRA pPCI group(p< 0.01 ). Although slight artery spasm of 4.7% cases in TRA pPCI group was happened during the procedure of PCI , the procedure had being continued after administration of medicine to release the spasm. The time of Allen’s test ,diameter and the systolic velocity of blood in daul radial arteries were no significant change before and after pPCI.Conclusions The duration and effect by TRA pPCI for AMI with stable hemodynamics was similar to TFA pPCI. The complications such as of bleeding,vessel injury, thrombi and embolism by TRA pPCI were few, and it was unnecessary to discontinue the anticoagulation medicine. TRA pPCI might be selected as a access vessel for pPCI in AMI patients with stable hemodynamics.
文摘Objective This study was to evaluate the efficacy and safety of a short acting reduced dose fibrinolytic regimen to promote early infarct related artery (IRA) patency for acyute myocardial infarction (AMI) patients referred for percutaneous coronary intervention (PCI).Methods Following aspirin and heparin, 166 patients were randomized to a 50 mg bolus of recombinant tissue type plasminogen activator(rt PA) or to a same volume sodium chloride injection followed by immediate primary PCI. The end points included patency rates on catheterization laboratory (cath lab) arrival, revascularization results when PCI was performed, complication rates, left ventricular function and restored patency rate following PCI. Results Patency on cath lab arrival was 64% with rt PA (34% TIMI 3,30% TIMI 2), while 31% of placebo (13% TIMI 3, 18% TIMI 2). There was no difference in the restored TIMI 3 rates of IRA between the two groups (85% vs 87%). No difference were observed in stroke or major bleeding. Left ventricular function was similar in both groups (52±9% vs 50±8%), but left ventricular ejection fraction fraction (LVEF) was higher with patent IRA (TIMI 3) on cath lab arrival than that of others (56±12% vs 48±10%).Conclusions Strategy thrombolytic regimens were compatible with subsequent PCI lead to more frequenc early recanalization (before cath lab arrival), which facilitates greater left ventricular function preservation with no augmentation of adverse events.
文摘Acute cardiomyocyte necrosis in the infarcted heart generates damage-associated molecular patterns, activating complement and toll-like receptor/interleukin-1 signaling, and triggering an intense inflammatory response. Iuflammasomes also recognize danger signals and mediate sterile inflammatory response following acute myocardial infarction （AMI）, Inflammatory response serves to repair the heart, but excessive inflammation leads to adverse left ventricular remodeling and heart failure. In addition to local inflammation, profound systemic inflammation response has been documented in patients with AMI, which includes elevation of circulating inflammatory cytokines, chemokines and cell adhesion molecules, and activation of peripheral leukocytes and platelets. The excessive inflammatory response could be caused by a deregulated immune system. AMI is also associated with bone marrow activation and spleen monocytopoiesis, which sustains a continuous supply of monocytes at the site of inflammation. Accumulating evidence has shown that systemic inflammation aggravates atherosclerosis and markers for systemic inflammation are predictors of adverse clinical outcomes （such as death, recurrent myocardial in- farction, and heart failure） in patients with AMI.
文摘Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction （STEMI） who undergo percutaneous coronary intervention （PCI） and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction （AMI） undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow （no-flow score 〉 10, by using a no-flow risk prediction model, n = 216） were randomly divided into a controlled group （n = 108） and a combination therapy group （n = 108）. Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose （80 mg） atorvastatin pre-treatment, intracoronary administration of adenosine （140 ~tg/min per kilogram） during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist （tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute） and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events （MACE） were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group （35.2%, P 〈 0.01）. The myocardial perfusion （A= 13） values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six （6.3%） MACE events （one death, two non-fatal MIs and three revasculafizations） in combination therapy group and 12 （13.2%） （four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05） in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow.
文摘Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.
