Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from t...Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.展开更多
Objective:Present study aimed to explore the effects of intermittent cold-exposure(ICE)on culprit plaque morphology in patients with ST-segment elevation myocardial infarction(STEMI)in frigid zone.Methods:Totally 848 ...Objective:Present study aimed to explore the effects of intermittent cold-exposure(ICE)on culprit plaque morphology in patients with ST-segment elevation myocardial infarction(STEMI)in frigid zone.Methods:Totally 848 STEMI patients with plaque rupture(N=637)or plaque erosion(N=211)were enrolled consecutively according to optical coherence tomography imaging.Data on the changes of outdoor air temperature corresponding to 24 solar terms were collected.Patients were divided into different groups according to 24 solar terms and the number of days with indoor central heating.Imaging data were measured and analyzed qualitatively and quantitatively.Statistical analysis was conducted to elucidate the possible association of the STEMI patients of different groups with plaque morphology of culprit vessel with alterations of ambient temperature.Results:The incidence of both plaque rupture and plaque erosion presented trough in summer.The incidence of plaque rupture reached a peak value in early winter when outdoor air temperature dropped below 0℃and declined with supply of central heating.Persistent cold exposure in early winter was positively and significantly associated with plaque rupture.The incidence of plaque erosion presented a peak in severe winter with outdoor air temperature dropping below-20℃and steady supply of central heating.ICE in severe winter was positively and significantly associated with plaque with intact intima,especially in aged male or current smoking patients.The positive correlation of cold exposure with lipid size in culprit plaque in winter weakened with central heating.Conclusion:ICE resulted from switching staying in between outdoor cold environment and indoor warm temperature with central heating in severe winter changed culprit plaque morphology in STEMI.Plaque rupture decreased whereas plaque erosion increased impacted by ICE.The effect of ICE on the transformation of plaque morphology might be explained by reduced lipid deposition.展开更多
Objective:To explore the diagnostic value of vectorcardiography(VCG)combined with color Doppler echocardiography(CDE)for acute inferior myocardial infarction(MI)culprit vessel.Methods:A total of 82 patients who had be...Objective:To explore the diagnostic value of vectorcardiography(VCG)combined with color Doppler echocardiography(CDE)for acute inferior myocardial infarction(MI)culprit vessel.Methods:A total of 82 patients who had been clinically diagnosed as acute inferior MI and had received coronary arteriography(CAG)were selected as research objects.They received bedside VCG and CDE examinations after admission.Their culprit vessels were analyzed and compared with CAG results to evaluate the diagnostic efficiency.Results:The detection rate of acute inferior MI culprit vessel by VCG combined with CDE was 76.83%,including 18 left circumflex(LCX)branches and 45 right coronary arteries(RCA).The lower left constituent ratio of LCX was 61.11%,which was significantly higher than 20.00%in RCA(p<0.05);the lower right constituent ratio of RCA was 71.11%,which was much higher than 11.11%in LCX(p<0.05);the sensitivity and the accuracy of RCA culprit vessel judged with frontal plane ST-vector pointing to the lower right quadrant were 71.11%and 53.33%respectively;the diagnostic efficiency of LCX culprit vessel judged with frontal plane ST-vector pointing to the lower left quadrant was 61.11%and 50.00%respectively.The maximum amplitude of the frontal plane in LCX culprit vessel was significantly lower than that in RCA culprit vessel;and the frontal plane vector angle in LCX was significantly greater than that in RCA culprit vessel(p<0.05).Conclusions:VCG combined with CDE can effectively diagnose acute inferior MI.It has a good diagnostic efficiency by judging culprit vessels according to the frontal plane ST-vector direction.展开更多
Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infar...Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.展开更多
Background Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment o...Background Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）.Methods We performed 18 intravascular ultrasound assessments preintervention during the primary PCi for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane （EEM）, lumen, and plaque plus media （P＆M） area. Positive remodeling was defined as lesion/mean reference EEM 〉1.0. Culprit lesions were identified by a combination of electrocardiogram （ECG） and coronary angiography.Results There was an average of- 1.44 infarct-related artery （IRA） plaques per patient. The incidences of thrombus and plaque ruptures were 28% （5） and 33% （6）, respectively. Hypoechoic plaque was observed in 72% （13） of AMI patients. Calcified lesions could be found in 33% （6） of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling.Conclusions Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling.展开更多
The challenge of diagnosis delay in inflammatory bowel disease(IBD)has emerged as a significant concern for both patients and healthcare professionals.The widely accepted notion that there is an extended time frame fr...The challenge of diagnosis delay in inflammatory bowel disease(IBD)has emerged as a significant concern for both patients and healthcare professionals.The widely accepted notion that there is an extended time frame from the onset of symptoms to the definitive diagnosis is often attributed to the heterogeneity of IBD and the non-specificity of clinical manifestations.Specific to patients with Crohn’s disease,the issue of delayed diagnosis appears to be more pronounced across different regions globally.The intricate interplay of real-world factors has led to debates regarding the primary contributors to these diagnostic delays.Drawing a comparison solely between patients and physicians and implicating the latter as the predominant influence factor may fall into a simplistic either-or logical trap that may obscure the truth.This letter,grounded in published evidence,explores areas for improvement in a forthcoming paper within the field,hoping to pinpoint the culprit behind the diagnosis delay issue for IBD patients rather than simply attributing it to so-called“physician-dependent factors”.Our objective is to motivate healthcare providers and policymakers in relevant fields to reflect on strategies for addressing this problem to reduce diagnostic delays and enhance patient outcomes.展开更多
文摘Background The clinical significance of complete revascularization for ST segment elevation myocardial infarction （STEMI） pa- tients during admission is still debatable. Methods A total of 1406 STEMI patients from the Korean Myocardial Infarction Registry with multivessel diseases without cardiogenic shock who underwent primary percutaneous coronary intervention （PPCI） were analyzed. We used propensity score matching （PSM） to control differences of baseline characteristics between culprit only intervention （CP） and multivessel percutaneous coronary interventions （MP）, and between double vessel disease （DVD） and triple vessel disease （TVD）. The major adverse cardiac event （MACE） was analyzed for one year after discharge. Results TVD patients showed higher incidence of MACE （14.2% vs. 8.6%, P = 0.01）, any cause of revascularization （10.6% vs. 5.9%, P - 0.01）, and repeated PCI （9.5% vs. 5.7%, P = 0.02）, as compared to DVD patients during one year after discharge. MP reduced MACE effectively （7.3% vs. 13.8%, P = 0.03）, as compared to CP for one year, but all cause of death （1.6% vs. 3.2%, P= 0.38）, Ml （0.4% vs. 0.8%, P = 1.00）, and any cause ofrevascularization （5.3% vs. 9.7%, P = 0.09） were comparable in the two treatment groups. Conclusions STEMI patients with TVD showed higher rate of MACE, as compared to DVD MP performed during PPCI or ad hoc during admission for STEMI patients without cardiogenic shock showed lower rate of MACE in this large scaled database. Therefore, MP could be considered as an effective treatment option for STEMI patients without cardiogenic shock.
基金The study protocol was approved by the Ethics Committee of the Second Affiliated Hospital of Harbin Medical University(KY2017-249)all patients provided written informed consent prior to the inclusion in the study and the investigation conformed to the principles outlined in the Declaration of Helsinki.
文摘Objective:Present study aimed to explore the effects of intermittent cold-exposure(ICE)on culprit plaque morphology in patients with ST-segment elevation myocardial infarction(STEMI)in frigid zone.Methods:Totally 848 STEMI patients with plaque rupture(N=637)or plaque erosion(N=211)were enrolled consecutively according to optical coherence tomography imaging.Data on the changes of outdoor air temperature corresponding to 24 solar terms were collected.Patients were divided into different groups according to 24 solar terms and the number of days with indoor central heating.Imaging data were measured and analyzed qualitatively and quantitatively.Statistical analysis was conducted to elucidate the possible association of the STEMI patients of different groups with plaque morphology of culprit vessel with alterations of ambient temperature.Results:The incidence of both plaque rupture and plaque erosion presented trough in summer.The incidence of plaque rupture reached a peak value in early winter when outdoor air temperature dropped below 0℃and declined with supply of central heating.Persistent cold exposure in early winter was positively and significantly associated with plaque rupture.The incidence of plaque erosion presented a peak in severe winter with outdoor air temperature dropping below-20℃and steady supply of central heating.ICE in severe winter was positively and significantly associated with plaque with intact intima,especially in aged male or current smoking patients.The positive correlation of cold exposure with lipid size in culprit plaque in winter weakened with central heating.Conclusion:ICE resulted from switching staying in between outdoor cold environment and indoor warm temperature with central heating in severe winter changed culprit plaque morphology in STEMI.Plaque rupture decreased whereas plaque erosion increased impacted by ICE.The effect of ICE on the transformation of plaque morphology might be explained by reduced lipid deposition.
文摘Objective:To explore the diagnostic value of vectorcardiography(VCG)combined with color Doppler echocardiography(CDE)for acute inferior myocardial infarction(MI)culprit vessel.Methods:A total of 82 patients who had been clinically diagnosed as acute inferior MI and had received coronary arteriography(CAG)were selected as research objects.They received bedside VCG and CDE examinations after admission.Their culprit vessels were analyzed and compared with CAG results to evaluate the diagnostic efficiency.Results:The detection rate of acute inferior MI culprit vessel by VCG combined with CDE was 76.83%,including 18 left circumflex(LCX)branches and 45 right coronary arteries(RCA).The lower left constituent ratio of LCX was 61.11%,which was significantly higher than 20.00%in RCA(p<0.05);the lower right constituent ratio of RCA was 71.11%,which was much higher than 11.11%in LCX(p<0.05);the sensitivity and the accuracy of RCA culprit vessel judged with frontal plane ST-vector pointing to the lower right quadrant were 71.11%and 53.33%respectively;the diagnostic efficiency of LCX culprit vessel judged with frontal plane ST-vector pointing to the lower left quadrant was 61.11%and 50.00%respectively.The maximum amplitude of the frontal plane in LCX culprit vessel was significantly lower than that in RCA culprit vessel;and the frontal plane vector angle in LCX was significantly greater than that in RCA culprit vessel(p<0.05).Conclusions:VCG combined with CDE can effectively diagnose acute inferior MI.It has a good diagnostic efficiency by judging culprit vessels according to the frontal plane ST-vector direction.
文摘Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.
文摘Background Intravascular ultrasound has become the standard invasive method for diagnosing coronary artery disease. The aim of the present study was to evaluate the ability of intravascular ultrasound for assessment of culprit lesion morphology during primary percutaneous coronary intervention （PCI） in patients with acute myocardial infarction （AMI）.Methods We performed 18 intravascular ultrasound assessments preintervention during the primary PCi for AMI. intravascular ultrasound analysis included qualitative and quantitative measurements of reference and lesion external elastic membrane （EEM）, lumen, and plaque plus media （P＆M） area. Positive remodeling was defined as lesion/mean reference EEM 〉1.0. Culprit lesions were identified by a combination of electrocardiogram （ECG） and coronary angiography.Results There was an average of- 1.44 infarct-related artery （IRA） plaques per patient. The incidences of thrombus and plaque ruptures were 28% （5） and 33% （6）, respectively. Hypoechoic plaque was observed in 72% （13） of AMI patients. Calcified lesions could be found in 33% （6） of culprit lesions. Sixty percent of the culprit lesion sites presented with positive remodeling.Conclusions Intravascular ultrasound is a safe and feasible imaging modality in patients with AMI and can help identify plaque rupture, intracoronary thrombus or calcification. The culprit lesion site in AMI cases often presents with positive remodeling.
基金Supported by the Education and Teaching Reform Project of the First Clinical College of Chongqing Medical University,No.CMER202305Natural Science Foundation of Tibet Autonomous Region,No.XZ2024ZR-ZY100(Z).
文摘The challenge of diagnosis delay in inflammatory bowel disease(IBD)has emerged as a significant concern for both patients and healthcare professionals.The widely accepted notion that there is an extended time frame from the onset of symptoms to the definitive diagnosis is often attributed to the heterogeneity of IBD and the non-specificity of clinical manifestations.Specific to patients with Crohn’s disease,the issue of delayed diagnosis appears to be more pronounced across different regions globally.The intricate interplay of real-world factors has led to debates regarding the primary contributors to these diagnostic delays.Drawing a comparison solely between patients and physicians and implicating the latter as the predominant influence factor may fall into a simplistic either-or logical trap that may obscure the truth.This letter,grounded in published evidence,explores areas for improvement in a forthcoming paper within the field,hoping to pinpoint the culprit behind the diagnosis delay issue for IBD patients rather than simply attributing it to so-called“physician-dependent factors”.Our objective is to motivate healthcare providers and policymakers in relevant fields to reflect on strategies for addressing this problem to reduce diagnostic delays and enhance patient outcomes.
