Accurate segmentation of infarct tissue in ischemic stroke is essential to determine the extent of injury and assess the risk and choose optimal treatment for this life-threatening disease.With the prior knowledge tha...Accurate segmentation of infarct tissue in ischemic stroke is essential to determine the extent of injury and assess the risk and choose optimal treatment for this life-threatening disease.With the prior knowledge that asymmetric analysis of anatomical structures can provide discriminative information,plenty of symmetry-based approaches have emerged to detect abnormalities in brain images.However,the inevitable non-pathological noise has not been fully alleviated and weakened,leading to unsatisfactory results.A novel differential rectification and refinement network(DRRN)for the automatic segmentation of ischemic strokes is proposed.Specifically,a differential feature perception encoder(DFPE)is developed to fully exploit and propagate the bilateral quasi-symmetry of healthy brains.In DFPE,an erasure-rectification(ER)module is devised to rectify pseudo-lesion features caused by non-pathological noise through utilising discriminant features within the symmetric neighbourhood of the original image.And a differentialattention(DA)mechanism is also integrated to fully perceive the differences in crossaxial features and estimate the similarity of long-range spatial context information.In addition,a crisscross differential feature reinforce module embedded with multiple boundary enhancement attention modules is designed to effectively integrate multi-scale features and refine textual details and margins of the infarct area.Experimental results on the public ATLAS and Kaggle dataset demonstrate the effectiveness of DRRN over state-of-the-arts.展开更多
BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular ...BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.展开更多
Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or ...Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.展开更多
Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients wer...Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups： （1） according to the age： age 〈65 years group and age ≥65 years group; （2） according to thrombolysis in myocardial ischemia trial （TIMI） lib risk stratification scoring system： score 〈4 group and ≥4 group; （3） according to serum creatinine （sCr） level： sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction （AMI） patients during the same period were divided into ST segment elevation myocardial infarction （STEMI） group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results （1） The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction （sCr 〉 178 μmol· L^-1 ）and triple vessel disease. Fewer patients in this group received coronary artery angiography （CAG）, percutaneous coronary intervention （PCI） and coronary artery bypass graft （CABG）. More number of deaths in this group compared with the age 〈 65 years group. （2） The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. （3） Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus （NIDDM）, patients with cardiac troponin T （CTnT） 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.（4） STEMI and NSTEMI patients were compared in same time frame as follows： fewer NSTEMI patients and more elderly patients had no chest pain, NID- DM, hypertension, dyslipidemia, left main coronary artery （LMCA） disease while CTnT ≥3.0 ng· ml^- ; fewer patients with aneurysm （30 days） underwent CAG, PCI and CABG treatment. However, there were no significant differences in smokers, patients with less than 50% stenosis in any vessel, 1 - 3 vessel disease, acute left ventricle heart failure, cardiogenic shock, serious arrhythmia and deaths. （5） The multivariate logistic regression analysis showed that death in NSTEMI was directly influenced by malignant arrhythmias with age ≥70 years. Conclusions Patients with NSTEMI were older, had more risk factors and presented more serious vessel disease, therefore, less of them could receive standard treatment. Complications and mortality of patients with NSTEMI were similar to that of patients with STEMI. Thus, NSTEMI is a serious disease with poor prognosis. NSTEMI patients may present with atypical chest pain and electrocardiogram changes, so are easily missed or loss diagnosed.展开更多
Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocard...Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI）. Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI （80.12ng/ml VS.73.01ng/ml, P 〈0.01）, while CRP levels were not significantly different between patient with STEMI and NSTEMI （3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05）. PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels展开更多
Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation...Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.展开更多
Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with ...Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with poor outcomes. Multivessel coronary artery disease（MVCAD） is considered to be a potentially important risk factor for CIN. There are still no data on CIN in patients undergoing staged PCI for STEMI and MVCAD. Therefore, we explored the incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population. Methods From 2011 to 2018, we enrolled 103 consecutive patients with STEMI who underwent staged PCI for MVCAD. CIN was defined as a relative increase of 〉 25% or an absolute increase of ≥ 0.5 mg/dL in SCr from the baseline value 72 h after exposure to the contrast medium. The incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population were studied. Results We found1） the incidence of CIN after primary PCI and staged PCI was 16.50% and 25.20%, respectively. 2） patients with CIN had worse in-hospital and follow-up outcomes. 3） in multivariate logistic analysis, independent risk factors for CIN included：（1） lower creatinine clearance at baseline;（2） atrioventricular block requiring temporary cardiac pacemaker implantation;（3） use of IABP at baseline;（4） total contrast volume administered（ primary PCI ＋staged PCI）;（5） shorter time interval between primary PCI and staged PCI. Conclusions CIN is a frequent complication in patients with STEMI and MVCAD undergoing staged PCI. The development of CIN is associated with worse in-hospital and follow-up outcomes.展开更多
To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h o...To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h of symptom onset.However,in realworld clinical practice,the implementation of PPCI faces substantial operational challenges,particularly in resource-limited settings,such as inadequate availability of specialized cardiac catheterization teams with requisite procedural expertise or the complete absence of coronary intervention capabilities in numerous rural healthcare facilities across China.Consequently,fibrinolytic therapy remains the predominant reperfusion strategy for STEMI management in county-level hospitals,with particularly high utilization rates observed in geographically remote regions.[3,4]Furthermore,our previous study revealed that 42.5%of STEMI patients fail to receive any form of evidence-based reperfusion therapy,representing a critical gap in optimal care delivery.To elucidate the prognostic implications of these treatment pathways within China’s unique healthcare system,this study aimed to compare the long-term outcomes among STEMI patients receiving PPCI,fibrinolysis,and no reperfusion therapy using data from the China Acute Myocardial Infarction Registry(CAMI Registry,clinicaltrials.gov,NCT01874691).展开更多
To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients ...To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients hospitalized between January 2017 and December 2021 were randomly assigned into two groups:the experimental group and the control group,each comprising 140 cases.The control group received ticagrelor combined with prourokinase thrombolysis,while the experimental group received ticagrelor combined with reteplase thrombolysis.The impact of these treatments on cardiac function and blood-related indexes in STEMI patients was assessed.Results revealed that CK-MB,AST,and LDH levels significantly decreased after 7 d of treatment compared to pre-treatment levels,with the experimental group exhibiting lower levels compared to the control group.Additionally,NT-pro BNP levels decreased in both groups after 24 h of treatment,with the experimental group showing a greater reduction compared to the control group.Furthermore,LVEF and E/A values significantly increased after 7 d of treatment in both groups,while LVEDd and LVESd values notably decreased,indicating improved cardiac function in the experimental group compared to the control group.Following treatment,levels of PT,TT,and APTT increased in both groups,while FIB levels decreased significantly,with noticeable differences between the two groups.The incidence of major adverse cardiovascular events(MACE)in the experimental group was significantly lower compared to the control group,although the rate of mild bleeding did not significantly differ.In conclusion,the combination of ticagrelor and reteplase demonstrated superior efficacy in reducing myocardial enzyme and NT-pro BNP levels,improving cardiac function,and enhancing safety compared to ticagrelor and prourokinase.These findings suggested that ticagrelor combined with reteplase thrombolysis held promise for clinical application.展开更多
Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infar...Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.展开更多
Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary interventio...Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).展开更多
Background and Objectives:This study aimed to assess the predictive power of the Geriatric Nutritional Risk Index(GNRI)and the triglyceride-glucose(TyG)index for poor prognosis in non-ST segment elevation acute corona...Background and Objectives:This study aimed to assess the predictive power of the Geriatric Nutritional Risk Index(GNRI)and the triglyceride-glucose(TyG)index for poor prognosis in non-ST segment elevation acute coronary syndrome(NSTE-ACS)patients post-percutaneous coronary intervention(PCI).Methods and Study Design:A cohort of 393 NSTE-ACS patients who underwent PCI at the People’s Hospital of Nanjing Jiangbei from 2016 to 2022 was analyzed.Major adverse cardiovascular events(MACEs),including death,non-fatal myocardial infarction,and target vessel revascularization,served as the primary outcome.Relationships between GNRI,TyG index,and MACEs were explored using univariate and multivariate logistic regression,with results presented as odds ratios(OR)and 95%confidence intervals(CI).The predictive value was further evaluated using the area under the curve(AUC)from the receiver operating characteristic(ROC)curve.Results:MACEs occurred in 34 patients.A TyG index≥1.36 was associated with a significantly increased risk of MACEs(OR=5.07,95%CI:1.64-15.71),while a GNRI≥108 indicated a decreased risk(OR=0.17,95%CI:0.04-0.68).These associations were consistent across various subgroups,including age,gender,and specific pre-existing conditions.The combined predictive value of TyG index and GNRI was higher than each alone(AUC=0.711,95%CI:0.642-0.779).Conclusions:In post-PCI patients with NSTE-ACS,the TyG index and GNRI are significant predictors of MACEs,with the TyG index indicating higher risk and GNRI lower risk.Their combined use may enhance the predictive accuracy for MACEs in this patient population.展开更多
Heart failure(HF)represents a multifaceted clinical syndrome featured by cardiac structural or functional abnormalities secondary to diverse etiologies.Neurohormonal activation,including sympathetic nervous system(SNS...Heart failure(HF)represents a multifaceted clinical syndrome featured by cardiac structural or functional abnormalities secondary to diverse etiologies.Neurohormonal activation,including sympathetic nervous system(SNS)and the renin-angiotensin-aldosterone system(RAAS),is one of the most important mechanisms underlying the pathogenesis of HF.Since the 1990s,a growing number of experimental and clinical studies have shown that immunoinflammation makes an important contribution to the pathogenesis of HF.Recently,the immunoinflammation mechanisms of HF have been highlighted by clinical studies showing that interleukin(IL)-1β antagonists can prevent HF in patients with coronary heart disease(CHD)and acute ST-segment elevation myocardial infarction(STEMI).展开更多
基金National Natural Science Foundation of China,Grant/Award Number:No.62171251Natural Science Foundation of Guangdong Province,Grant/Award Number:No.2020A1515010711。
文摘Accurate segmentation of infarct tissue in ischemic stroke is essential to determine the extent of injury and assess the risk and choose optimal treatment for this life-threatening disease.With the prior knowledge that asymmetric analysis of anatomical structures can provide discriminative information,plenty of symmetry-based approaches have emerged to detect abnormalities in brain images.However,the inevitable non-pathological noise has not been fully alleviated and weakened,leading to unsatisfactory results.A novel differential rectification and refinement network(DRRN)for the automatic segmentation of ischemic strokes is proposed.Specifically,a differential feature perception encoder(DFPE)is developed to fully exploit and propagate the bilateral quasi-symmetry of healthy brains.In DFPE,an erasure-rectification(ER)module is devised to rectify pseudo-lesion features caused by non-pathological noise through utilising discriminant features within the symmetric neighbourhood of the original image.And a differentialattention(DA)mechanism is also integrated to fully perceive the differences in crossaxial features and estimate the similarity of long-range spatial context information.In addition,a crisscross differential feature reinforce module embedded with multiple boundary enhancement attention modules is designed to effectively integrate multi-scale features and refine textual details and margins of the infarct area.Experimental results on the public ATLAS and Kaggle dataset demonstrate the effectiveness of DRRN over state-of-the-arts.
文摘BACKGROUND The incidence of acute myocardial infarction(AMI)is rising,with cardiac rupture accounting for approximately 2%of deaths in patients with acute ST-segment elevation myocardial infarction(STEMI).Ventricular free wall rupture(FWR)occurs in approximately 2%of AMI patients and is notably rare in patients with non-STEMI.Types of cardiac rupture include left ventricular FWR,ventricular septal rupture,and papillary muscle rupture.The FWR usually leads to acute cardiac tamponade or electromechanical dissociation,where standard resuscitation efforts may not be effective.Ventricular septal rupture and papillary muscle rupture often result in refractory heart failure,with mortality rates over 50%,even with surgical or percutaneous repair options.CASE SUMMARY We present a rare case of an acute non-STEMI patient who suffered sudden FWR causing cardiac tamponade and loss of consciousness immediate before undergoing coronary angiography.Prompt resuscitation and emergency open-heart repair along with coronary artery bypass grafting resulted in successful patient recovery.CONCLUSION This case emphasizes the risks of AMI complications,shares a successful treatment scenario,and discusses measures to prevent such complications.
基金supported by the National Key Research and Development Program of China(No.2022YFB380-7300)the National Natural Science Foundation of China(No.12471455)+2 种基金the Clinical Cohort Construction Program of Peking University Third Hospital(BYSYDL2022005)the Key Clinical Projects of Peking University Third Hospital(BYSYZD2023006)the Innovation&Transfer Fund of Peking University Third Hospital(BYSYZHKC2023-109).
文摘Kounis syndrome(KS)is a rare but clinically significant condition characterized by the simultaneous occurrence of acute coronary syndrome(ACS)and allergic reactions,which can develop in patients with either normal or diseased coronary arteries.[1,2]The condition is typically triggered by various allergens including medications(particularly contrast media),environmental factors,or food exposures,with symptom onset usually occurring within one hour of exposure.
文摘Objectives To analyze the clinical characteristics of 216 patients with non-ST segment elevation myocardial infarction （NSTEMI）. Methods A retrospective analysis was used. Two hundred and sixteen NSTEMI patients were divided into two groups： （1） according to the age： age 〈65 years group and age ≥65 years group; （2） according to thrombolysis in myocardial ischemia trial （TIMI） lib risk stratification scoring system： score 〈4 group and ≥4 group; （3） according to serum creatinine （sCr） level： sCr level ≤ 178 μmol · L^-1 group and 〉 178 μmol · L^-1 group. Seven hundred and eighty six acute myocardial infarction （AMI） patients during the same period were divided into ST segment elevation myocardial infarction （STEMI） group and NSTEMI group. Clinical characteristics of the patients in the two groups were compared. Results （1） The number of NSTEMI patients in age ≥65 years group is significantly greater than that in age 〈 65 years group. Study revealed that the patients in age ≥ 65 years group were without chest pain, had hypertension, dyslipidemia, atrial fibrillation, cardiac and renal dysfunction （sCr 〉 178 μmol· L^-1 ）and triple vessel disease. Fewer patients in this group received coronary artery angiography （CAG）, percutaneous coronary intervention （PCI） and coronary artery bypass graft （CABG）. More number of deaths in this group compared with the age 〈 65 years group. （2） The number of NSTEMI patients in TIMI score 〉 4 group is significantly greater than that in TIMI score 〈 4 group. Four major complications such as acute left ventricular failure, cardiogenic shock, serious arrhythmia and deaths, increased significantly in TIMI score 〉 4 group comparing with TIMI score ≤〈4 group. （3） Obviously, more number of elderly patients, non-insulin dependant diabetes mellitus （NIDDM）, patients with cardiac troponin T （CTnT） 〉3.0 ng· L^-1 and deaths occurred in sCr 〉 178 μmol · L^-1 group.（4） STEMI and NSTEMI patients were compared in same time frame as follows： fewer NSTEMI patients and more elderly patients had no chest pain, NID- DM, hypertension, dyslipidemia, left main coronary artery （LMCA） disease while CTnT ≥3.0 ng· ml^- ; fewer patients with aneurysm （30 days） underwent CAG, PCI and CABG treatment. However, there were no significant differences in smokers, patients with less than 50% stenosis in any vessel, 1 - 3 vessel disease, acute left ventricle heart failure, cardiogenic shock, serious arrhythmia and deaths. （5） The multivariate logistic regression analysis showed that death in NSTEMI was directly influenced by malignant arrhythmias with age ≥70 years. Conclusions Patients with NSTEMI were older, had more risk factors and presented more serious vessel disease, therefore, less of them could receive standard treatment. Complications and mortality of patients with NSTEMI were similar to that of patients with STEMI. Thus, NSTEMI is a serious disease with poor prognosis. NSTEMI patients may present with atypical chest pain and electrocardiogram changes, so are easily missed or loss diagnosed.
文摘Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 （PAI-1） levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction （ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI）. Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI- 1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI （80.12ng/ml VS.73.01ng/ml, P 〈0.01）, while CRP levels were not significantly different between patient with STEMI and NSTEMI （3.87 ± 0.79 mg/ml VS.4.01 ±0.69mg/ml, P〉0.05）. PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels
基金supported by the Beijing Tsinghua Changgung Hospital Fund(grant No.12019C1009).
文摘Objectives:Meta-analysis was performed to evaluate the effect of staged revascularization with concomitant chronic total occlusion(CTO)in the non-infarct-associated artery(non-IRA)in patients with ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(p-PCI).Methods:Various electronic databases were searched for studies published from inception to June,2021.The primary endpoint was all-cause death,and the secondary endpoint was a composite of major adverse cardiac events(MACEs).Odds ratios(ORs)were pooled with 95%confidence intervals(CIs)for dichotomous data.Results:Seven studies involving 1540 participants were included in thefinal analysis.Pooled analyses revealed that patients with successful staged revascularization for CTO in non-IRA with STEMI treated with p-PCI had overall lower all-cause death compared with the occluded CTO group(OR,0.46;95%CI,0.23–0.95),cardiac death(OR,0.43;95%CI,0.20–0.91),MACEs(OR,0.47;95%CI,0.32–0.69)and heart failure(OR,0.57;95%CI,0.37–0.89)com-pared with the occluded CTO group.No significant differences were observed between groups regarding myocardial infarction and repeated revascularization.Conclusions:Successful revascularization of CTO in the non-IRA was associated with better outcomes in patients with STEMI treated with p-PCI.
文摘Background Contrast-induced nephropathy（CIN） occurs frequently in patients undergoing primary percutaneous coronary intervention（PCI） for ST-segment elevation myocardial infarction（STEMI） and is associated with poor outcomes. Multivessel coronary artery disease（MVCAD） is considered to be a potentially important risk factor for CIN. There are still no data on CIN in patients undergoing staged PCI for STEMI and MVCAD. Therefore, we explored the incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population. Methods From 2011 to 2018, we enrolled 103 consecutive patients with STEMI who underwent staged PCI for MVCAD. CIN was defined as a relative increase of 〉 25% or an absolute increase of ≥ 0.5 mg/dL in SCr from the baseline value 72 h after exposure to the contrast medium. The incidence, risk factors, in-hospital and follow-up outcomes of CIN in this special population were studied. Results We found1） the incidence of CIN after primary PCI and staged PCI was 16.50% and 25.20%, respectively. 2） patients with CIN had worse in-hospital and follow-up outcomes. 3） in multivariate logistic analysis, independent risk factors for CIN included：（1） lower creatinine clearance at baseline;（2） atrioventricular block requiring temporary cardiac pacemaker implantation;（3） use of IABP at baseline;（4） total contrast volume administered（ primary PCI ＋staged PCI）;（5） shorter time interval between primary PCI and staged PCI. Conclusions CIN is a frequent complication in patients with STEMI and MVCAD undergoing staged PCI. The development of CIN is associated with worse in-hospital and follow-up outcomes.
基金supported by the Twelfth Five-Year Planning Project of the Scientific and Technological Department of China(No.2011BAI11B02)the CAMS Innovation Fund for Medical Sciences(CIFMS)(Nos.2020-I2M-C&T-B-050 and 2016-I2M-1-009).
文摘To the Editor:Contemporary guidelines recommend primary percutaneous coronary intervention(PPCI)as the gold-standard reperfusion modality in patients with ST-segment elevation myocardial infarction(STEMI)within 12 h of symptom onset.However,in realworld clinical practice,the implementation of PPCI faces substantial operational challenges,particularly in resource-limited settings,such as inadequate availability of specialized cardiac catheterization teams with requisite procedural expertise or the complete absence of coronary intervention capabilities in numerous rural healthcare facilities across China.Consequently,fibrinolytic therapy remains the predominant reperfusion strategy for STEMI management in county-level hospitals,with particularly high utilization rates observed in geographically remote regions.[3,4]Furthermore,our previous study revealed that 42.5%of STEMI patients fail to receive any form of evidence-based reperfusion therapy,representing a critical gap in optimal care delivery.To elucidate the prognostic implications of these treatment pathways within China’s unique healthcare system,this study aimed to compare the long-term outcomes among STEMI patients receiving PPCI,fibrinolysis,and no reperfusion therapy using data from the China Acute Myocardial Infarction Registry(CAMI Registry,clinicaltrials.gov,NCT01874691).
文摘To compare the effects of ticagrelor combined with prourokinase and reteplase thrombolysis on cardiac function and blood-related indexes in patients with ST-segment elevation myocardial infarction(STEMI),280 patients hospitalized between January 2017 and December 2021 were randomly assigned into two groups:the experimental group and the control group,each comprising 140 cases.The control group received ticagrelor combined with prourokinase thrombolysis,while the experimental group received ticagrelor combined with reteplase thrombolysis.The impact of these treatments on cardiac function and blood-related indexes in STEMI patients was assessed.Results revealed that CK-MB,AST,and LDH levels significantly decreased after 7 d of treatment compared to pre-treatment levels,with the experimental group exhibiting lower levels compared to the control group.Additionally,NT-pro BNP levels decreased in both groups after 24 h of treatment,with the experimental group showing a greater reduction compared to the control group.Furthermore,LVEF and E/A values significantly increased after 7 d of treatment in both groups,while LVEDd and LVESd values notably decreased,indicating improved cardiac function in the experimental group compared to the control group.Following treatment,levels of PT,TT,and APTT increased in both groups,while FIB levels decreased significantly,with noticeable differences between the two groups.The incidence of major adverse cardiovascular events(MACE)in the experimental group was significantly lower compared to the control group,although the rate of mild bleeding did not significantly differ.In conclusion,the combination of ticagrelor and reteplase demonstrated superior efficacy in reducing myocardial enzyme and NT-pro BNP levels,improving cardiac function,and enhancing safety compared to ticagrelor and prourokinase.These findings suggested that ticagrelor combined with reteplase thrombolysis held promise for clinical application.
文摘Objective To investigate the correlation between the hemodynamic pattern of non-culprit vessel stenosis and long-term vessel-oriented composite outcome(VOcO)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods From January 2019 to December 2021,233 consecutive patients with STEMI and non-culprit vessel stenosis were prospectively enrolled at Shanghai East Hospital.The median followup duration was 3.9 years.The 367 non-culprit vessels of the 233 patients were divided into the VOCO group(33 vessels,9.0%)and the non-VOCO group(334 vessels,91.0%).Parameters pertaining to the hemodynamic pattern of non-culprit vessel stenosis between the two groups were compared.Receiver operating characteristic(ROC)curvesswereused to assess the correlation between hemodynamic pattern and VoCO,and Cox multivariate regression and logistic multivariate regression analyses were applied to identify independent predictors of VOCO.Results The 233 enrolled patients were aged(62.5±12.9)years,with 193 males(82.8%).In the VOCO group,the maximum quantitative flow ratio(QFR)decreased within 20 mm of the QFR-assessed segment,the difference in QFR across the entire vessel,the length of functionally significant vessel,and the maximum gradient of QFR decrease(dQFR/dsmax)were significantly greater than those in the non-VOCO group.ROC curve analysis showed that the optimal threshold for predicting VOCO using dQFR/dsmax was 0.0096(area under the curve:0.691,95%CI:0.606-0.775,P<0.001).Multivariable Cox regression analysis revealed that dQFR/dsmax was an independent predictor of VOCO(HR=1.199,95%CI:1.070-1.343,P=0.002).When anatomical and functional stenosis severities were included in the model,a high pullback pressure gradient(PPG)index(HR=1.572,95%CI:1.052-2.351,P=0.027)emerged as an independent predictor of VOCO.Multivariable logistic regression analysis revealed that a low PPG index(OR=2.851,95%CI:1.945-4.178,P<0.001)was an independent predictor of QFR≤0.80 without long-term VOCO.Conclusion In patients with STEMI,localized hemodynamic patterns of coronary artery stenosis,characterized by high dQFR/dsmax and high PPG index,are associated with longterm VOCO.
文摘Objective: To evaluate the efficacy and short term prognosis of Tirofiban in different treatment duration in patients with acute ST segment elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI) combined with intracoronary injection. Methods: A total of 125 patients with acute STEMI were enrolled in this study. They were randomly divided into two groups: control group (n ? 61) and Tirofiban group (n ? 64). The Tirofiban was used by intracoronary and intravenous administration in Tirofiban group which was randomly divided into three sub-groups according to the duration of Tirofiban by persistent intravenous injection for 12 hours, 24 hours or 36 hours. Thrombolysis in myocardial infarction flow and myocardial perfusion grades were recorded immediately after PCI. The adverse cardiac events and cardiac death within 180 days of PCI, and the adverse effects (hemorrhage and thrombocytopenia) were compared between the two groups and within Tirofiban sub-groups. Results: Grade 3 in myocardial perfusion was significantly better in Tirofiban group than control group (85.94% vs. 72.13%, P ? 0.03) after PCI. There was one cardiac death in control group in 180 days after PCI. The adverse cardiac event rates between two groups was significant difference (16 patients in control group and only 8 in Tirofiban group, P ? 0.047). There was no significant difference in incidence of hemorrhage complications and platelet counts between two groups. Nevertheless, hemorrhage complications in the 12-and 24-hour subgroups were less than 36-hour subgroup (P ? 0.01). Conclusions: Intravenous Tirofiban treatment reduced the adverse cardiac events and improved short term prognosis without increasing the adverse reactions of the drugs in patients undergoing PCI. The less rate of hemorrhage complication can be achieved in short-duration of Tirofiban by intravenous injection after PCI. Copyright ? 2015, Chinese Medical Association Production. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
文摘Background and Objectives:This study aimed to assess the predictive power of the Geriatric Nutritional Risk Index(GNRI)and the triglyceride-glucose(TyG)index for poor prognosis in non-ST segment elevation acute coronary syndrome(NSTE-ACS)patients post-percutaneous coronary intervention(PCI).Methods and Study Design:A cohort of 393 NSTE-ACS patients who underwent PCI at the People’s Hospital of Nanjing Jiangbei from 2016 to 2022 was analyzed.Major adverse cardiovascular events(MACEs),including death,non-fatal myocardial infarction,and target vessel revascularization,served as the primary outcome.Relationships between GNRI,TyG index,and MACEs were explored using univariate and multivariate logistic regression,with results presented as odds ratios(OR)and 95%confidence intervals(CI).The predictive value was further evaluated using the area under the curve(AUC)from the receiver operating characteristic(ROC)curve.Results:MACEs occurred in 34 patients.A TyG index≥1.36 was associated with a significantly increased risk of MACEs(OR=5.07,95%CI:1.64-15.71),while a GNRI≥108 indicated a decreased risk(OR=0.17,95%CI:0.04-0.68).These associations were consistent across various subgroups,including age,gender,and specific pre-existing conditions.The combined predictive value of TyG index and GNRI was higher than each alone(AUC=0.711,95%CI:0.642-0.779).Conclusions:In post-PCI patients with NSTE-ACS,the TyG index and GNRI are significant predictors of MACEs,with the TyG index indicating higher risk and GNRI lower risk.Their combined use may enhance the predictive accuracy for MACEs in this patient population.
基金The Noncommunicable Chronic Diseases—National Science and Technology Major Project(Nos.2025ZD0548400 and 2023ZD0504600)the National Key Research and Development Program(No.2022YFC2503501)+1 种基金Hubei Technology Innovation Project(No.2024BCB046)Key Research and Development Program of Wuhan(No.2024020702030092).
文摘Heart failure(HF)represents a multifaceted clinical syndrome featured by cardiac structural or functional abnormalities secondary to diverse etiologies.Neurohormonal activation,including sympathetic nervous system(SNS)and the renin-angiotensin-aldosterone system(RAAS),is one of the most important mechanisms underlying the pathogenesis of HF.Since the 1990s,a growing number of experimental and clinical studies have shown that immunoinflammation makes an important contribution to the pathogenesis of HF.Recently,the immunoinflammation mechanisms of HF have been highlighted by clinical studies showing that interleukin(IL)-1β antagonists can prevent HF in patients with coronary heart disease(CHD)and acute ST-segment elevation myocardial infarction(STEMI).
