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
BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI ca...BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.展开更多
Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currentl...Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.展开更多
The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST eleva...The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.展开更多
Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for no...Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.展开更多
Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive pa...Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.展开更多
Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a n...Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.展开更多
Aiming to deal with the difficult issues of terrain data model simplification and crack disposal,the paper proposed an improved level of detail(LOD)terrain rendering algorithm,in which a variation coefficient of eleva...Aiming to deal with the difficult issues of terrain data model simplification and crack disposal,the paper proposed an improved level of detail(LOD)terrain rendering algorithm,in which a variation coefficient of elevation is introduced to express the undulation of topography.Then the coefficient is used to construct a node evaluation function in the terrain data model simplification step.Furthermore,an edge reduction strategy is combined with the improved restrictive quadtree segmentation to handle the crack problem.The experiment results demonstrated that the proposed method can reduce the amount of rendering triangles and enhance the rendering speed on the premise of ensuring the rendering effect compared with a traditional LOD algorithm.展开更多
BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in pr...BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).展开更多
BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular event...BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.展开更多
Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent p...Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.展开更多
Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patient...Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.展开更多
BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG patt...BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed STsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.展开更多
BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary pe...BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.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
Background Non-ST-segment elevation acute coronary syndrome （NSTE-ACS） is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques. Lead aVR ST- segmen...Background Non-ST-segment elevation acute coronary syndrome （NSTE-ACS） is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques. Lead aVR ST- segment elevation and cTnI positive are closely correlated to the prognosis of NSTE-ACS patients. However, there are few studies applying the two predictors to early risk stratification in NSTE-ACS patients. Method Two hundred and five cases of NSTE-ACS patients followed up for 6 months after discharge were reviewed. All patients were divided into four groups： Group A-cTnI negative combined with aVR-non-ST-segment elevation group （100 cases） ; Group B-cTnI negative combined with aVR-ST-segment elevation group （31 cases） ; Group C-cTnI positive combined with aVR-non-ST-segment elevation group （43 cases） ; Group D-cTnI positive combined with aVR-ST-segment elevation group （31 cases）. There was no significant difference in gender, age, old myocardial infarction, previous PCI history, hypertension, and diabetes between aVR-ST elevation group and no aVR-ST elevation group. The morbidity of left main or three-vessel coronary artery disease as well as adverse cardiovascular events in the four groups were observed and analyzed. Results （i） The morbidity of left main or three-vessel coronary artery disease was highest in Group D （87.1%） , and was markedly higher in Group B （41.9%） than that in Group A （7%） or Group C （9.3%） ; （ii） The incidence of adverse cardiovascular events was highest in Group D （77.4%）, and was much higher in B （35.5%） as compared with that tin Group A （1%） or group C （7%）. Conclusion Electrocardiographic lead aVR ST-segment elevation combined with cTnI positive has an important clinical value in predicting the prognosis of the patients with NSTE-ACS.展开更多
To investigate the value of N-terminal prohormone brain natriuretic peptide （NT-proBNP） in the evaiuation of the coronary artery condition （ degree of the coronary artery lesion severity and complexity） in patient...To investigate the value of N-terminal prohormone brain natriuretic peptide （NT-proBNP） in the evaiuation of the coronary artery condition （ degree of the coronary artery lesion severity and complexity） in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Eighty patients with STEMI diagnosed by electrocardiogram （ECG） were selected. The concentration of plasma NT-proBNP was measured by electrochemiluminescence immunoassay, and the value of NT-proBNP concentration to evaluate the degree of severity and complexity in coronary artery lesion by coronary angiography （CAG） was analyzed. Results The more serious and more complex of coronary artery lesion in patients with ST-segment elevation myocardial infarction, the higher the concentration of plasma NT-proBNP was （ P 〈 0. 05 ）. Conclusion The concentration of plasma NT-proBNP may be a useful marker to evaluate the degree of severity and complexity of coronary artery lesion in patients with ST-segment elevation myocardial infarction. （ S Chin J Cardiol 2009 ; 10 （ 1 ） ： 15-18）展开更多
A 53 years old female patient with hypertension presented with constrictive retrosternal chest pain. Initial Electrocardiogram (ECG) showed ST elevation in aVR and high level cardiac Troponin-I. Thrombolysis with stre...A 53 years old female patient with hypertension presented with constrictive retrosternal chest pain. Initial Electrocardiogram (ECG) showed ST elevation in aVR and high level cardiac Troponin-I. Thrombolysis with streptokinase was performed and she underwent?coronary angiography who showed a long tight anterior inter ventricular lesion, occlusion of the proximal circumflex and an intermediate lesion of segment 2 of the right coronary.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
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BACKGROUND Primary percutaneous coronary intervention(PCI)is the preferred treatment for ST-segment elevation myocardial infarction(STEMI).However,in patients with high thrombus burden,immediate stenting during PCI can lead to poor outcomes due to the risk of thrombus migration and subsequent microvascular occlusion,resulting in no-reflow phenomena.Deferred stenting offers a potential advantage by allowing for the reduction of thrombus load,which may help to minimize the incidence of slow-flow and no-reflow complications.This study explores the effectiveness of a deferred stenting strategy in improving outcomes for STEMI patients.AIM To evaluate the effectiveness and safety of deferred PCI in a real-world setting in acute STEMI patients.METHODS RESULTS Anterior wall myocardial infarction was the predominant type of STEMI in 62%of the selected 55 patients(mean age:54 years;70%males),and diabetes mellitus was the most common risk factor(18.2%),followed by hypertension(16.2%).On the second angiogram of these patients measures of thrombus grade,thrombolysis in myocardial infarction flow grade,myocardial blush grade,and severity of stenosis of culprit lesion were consid-erably improved compared to the first angiogram,and the average culprit artery diameter had increased by 7.8%.Most patients(60%)had an uneventful hospital stay during the second angiogram and an uneventful intrapro-cedural course(85.19%),with slow-flow/no-reflow occurring only in 7.4%of the patients;these patients recovered after taking vasodilator drugs.In 29.3%of patients,the culprit artery was recanalized,preventing unnecessary stent deployment.CONCLUSION Deferred PCI strategy is safe and reduces the thrombus burden,improves thrombolysis in myocardial infarction(TIMI)flow,improves myocardial blush grade,and prevents unwarranted stent deployment.
基金supported by the Hainan Province’s Key Research and Development Project(ZDYF 2017096&ZDYF2018118)National Natural Science Foundation of China(NSFC:81500202)+2 种基金Beijing Lisheng Cardiovascular Health Foundation Pilot Fund Project(LHJJ201610620)Provincial Key Science and Technology Projects supporting projects in Sanya(2018PT48)Sanya Medical and Health Science and Technology Innovation Project(2017YW10)
文摘Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. Thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.
基金Supported by John S Dunn Chair in Cardiology Research and Education
文摘The benefits of early perfusion in ST elevation myocardial infarctions(STEMI) are established; howeverearly perfusion of non-ST elevation myocardial infarctions has not been shown to be beneficial. In additionST elevation(STE) caused by conditions other thanacute ischemia is common. Non-ischemic STE may beconfused as STEMI, but can also mask STEMI on electrocardiogram(ECG). As a result, activating the primarypercutaneous coronary intervention(pPCI) protocooften depends on determining which ST elevation patterns reflect transmural infarction due to acute coronary artery thrombosis. Coordination of interpreting theECG in its clinical context and appropriately activatingthe pPCI protocol has proved a difficult task in borderline cases. But its importance cannot be ignored, asreflected in the 2013 American College of CardiologyFoundation/American Heart Association guidelines concerning the treatment of ST elevation myocardial infarction. Multiples strategies have been tested and studiedand are currently being further perfected. No mattethe strategy, at the heart of delivering the best care lies rapid and accurate interpretation of the ECG. Here, we present the different patterns of non-ischemic STE and methods of distinguishing between them. In writing this paper, we hope for quicker and better stratification of patients with STE on ECG, which will lead to be bet-ter outcomes.
文摘Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction(NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention(PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.
文摘Objective To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy. Methods 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed. Results The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10–1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56–8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77–6.75, P = 0.0003), 3.02 (95% CI: 1.52–6.01, P = 0.0017), 2.93 (95% CI: 1. 46–5.86, P = 0.0024) and 2.47 (95% CI: 1.20–5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001). Conclusions An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.
基金funded by the Ministry of Science and Technology of the People’s Republic of China,State Science and Technology Support Program (No.2011BAI11B05)Beijing Lab for Cardiovascular Precision Medicine, Beijing, China (PXM2019_014226_000023)
文摘Background In patients with acute ST-segment elevation myocardial infarction(STEMI)who undergo primary percutaneous coronary intervention(PCI),approximately 10%are concomitant with a chronic total occlusion(CTO)in a non-culprit vessel.However,the impact of staged CTO recanalization on prognosis in this cohort remains disputable.This study aimed to compare the long-term outcomes of staged CTO recanalization versus medical therapy in patients with STEMI after primary PCI.Methods Between January 2005 and December 2016,a total of 287 patients were treated with staged CTO-PCI(n=91)or medical therapy(n=196)after primary PCI in our center.The primary endpoint was major adverse cardiovascular and cerebrovascular event(MACCE),defined as a composite of all-cause death,nonfatal myocardial infarction(MI),stroke or unplanned revascularization.After propensity-score matching,77 pairs of well-balanced patients were identified.Results The mean follow-up period was 6.06 years.Overall,the incidence of the primary endpoint of MACCE was significantly lower in staged CTO-PCI group than that in medical therapy group in both overall population(22.0%vs.46.9%;hazard ratio(HR)=0.48,95%CI:0.29-0.77)and propensity-matched cohorts(22.1%vs.42.9%;HR:0.48,95%CI:0.27-0.86).In addition,staged CTO-PCI was also associated with reduced risk of the composite of cardiac death,nonfatal MI or stroke compared with medical therapy in both overall population(9.9%vs.26.5%;hazard ratio(HR)=0.39,95%CI:0.19-0.79)and propensity-matched cohorts(9.1%vs.22.1%;HR:0.40,95%CI:0.16-0.96).After correction of the possible confounders,staged CTO-PCI was independently associated with reduced risks of MACCE(adjusted HR:0.46,95%CI:0.28-0.75),the composite of cardiac death,nonfatal MI or stroke(adjusted HR:0.45,95%CI:0.22-0.94)and all-cause mortality(adjusted HR:0.32,95%CI:0.13-0.83).Moreover,the results of sensitivity analysis were almost concordant with the overall analysis.Conclusions In patients with STEMI and a concurrent CTO who undergo primary PCI,successful staged recanalization of CTO in the non-culprit vessels is associated with better clinical outcomes during long-term follow-up.
基金Supported by the National Natural Science Foundation of China(61363075)the National High Technology Research and Development Program of China(863 Program)(2012AA12A308)the Yue Qi Young Scholars Program of China University of Mining&Technology,Beijing(800015Z1117)
文摘Aiming to deal with the difficult issues of terrain data model simplification and crack disposal,the paper proposed an improved level of detail(LOD)terrain rendering algorithm,in which a variation coefficient of elevation is introduced to express the undulation of topography.Then the coefficient is used to construct a node evaluation function in the terrain data model simplification step.Furthermore,an edge reduction strategy is combined with the improved restrictive quadtree segmentation to handle the crack problem.The experiment results demonstrated that the proposed method can reduce the amount of rendering triangles and enhance the rendering speed on the premise of ensuring the rendering effect compared with a traditional LOD algorithm.
基金funded by grants from National Natural Science Foundation of China(81100141 and 81570322 for JJ,81320108003 for JW)jointly supported by Boston Scientific
文摘BACKGROUND: Stent failure is more likely in the lipid rich and thrombus laden culprit lesions underlying ST-segment elevation myocardial infarction(STEMI).This study assessed the effectiveness of post-dilatation in primary percutaneous coronary intervention(pPCI) for acute STEMI.METHODS: The multi-center POST-STEMI trial enrolled 41 consecutive STEMI patients with symptom onset <12 hours undergoing manual thrombus aspiration and Promus Element stent implantation.Patients were randomly assigned to control group(n=20) or post-dilatation group(n=21) in which a non-compliant balloon was inflated to >16 atm pressure.Strut apposition and coverage were evaluated by optical coherence tomography(OCT) after intracoronary verapamil administration via thrombus aspiration catheter, post pPCI and at 7-month follow-up.The primary endpoint was rate of incomplete strut apposition(ISA) at 7 months after pPCI.RESULTS: There were similar baseline characteristics except for stent length(21.9 [SD 6.5] mm vs.26.0 [SD 5.8] mm, respectively, P=0.03).In post-dilatation vs.control group, ISA rate was lower(2.5% vs.4.5%, P=0.04) immediately after pPCI without affecting final TIMI flow 3 rate(95.2% vs.95.0%, P>0.05) or corrected TIMI frame counts(22.6±9.4 vs.22.0±9.7, P>0.05); and at 7-month follow-up(0.7% vs.1.8%, P<0.0001), the primary study endpoint, with similar strut coverage(98.5% vs.98.4%, P=0.63) and 1-year rate of major adverse cardiovascular events(MACE).CONCLUSION: In STEMI patients, post-dilatation after stent implantation and thrombus aspiration improved strut apposition up to 7 months without affecting coronary blood flow or 1-year MACE rate.Larger and longer term studies are warranted to further assess safety(Clinical Trials.gov identifier: NCT02121223).
文摘BACKGROUND Kawasaki disease(KD)is an acute self-limiting febrile vasculitis that occurs during childhood and can cause coronary artery aneurysm(CAA).CAAs are associated with a high rate of adverse cardiovascular events.CASE SUMMARY A Korean 35-year-old man with a 30-year history of KD presented to the emergency room with chest pain.Emergent coronary angiography was performed as ST-segment elevation in the inferior leads was observed on the electrocardiogram.An aneurysm of the left circumflex(LCX)coronary artery was found with massive thrombi within.A drug-eluting 4.5 mm 23 mm-sized stent was inserted into the occluded area without complications.The maximal diameter of the LCX was 6.0 mm with a Z score of 4.7,suggestive of a small aneurysm considering his age,sex,and body surface area.We further present a case series of 19 patients with KD,including the current patient,presenting with acute coronary syndrome(ACS).Notably,none of the cases showed Z scores;only five patients(26%)had been regularly followed up by a physician,and only one patient(5.3%)was being treated with antithrombotic therapy before ACS occurred.CONCLUSION For KD presenting with ACS,regular follow up and medical therapy may be crucial for improved outcomes.
文摘Objective:We planned to investigate the effect of mean platelet volume(MPV)on in-hospital mortality and coronary risk factors in geriatric patients with ST segment elevation myocardial infarction(STEMI)who underwent primary percutaneous coronary intervention(PCI).Methods:We enrolled 194 consecutive STEMI patients.The study population was divided into two groups on the basis of admission MPVs.The high-MPV group(n=49)included patients in the highest tertile(>8.9 fL),and the low-MPV group(n=145)included patients with a value in the lower two tertiles(≤8.9 fL).Clinical characteristics,in-hospital mortality,cardiovascular risk factors,and outcomes of primary PCI were analyzed.Results:The patients in the high-MPV group were older,more of them had three-vessel disease,and they had higher in-hospital mortality.Patients with in-hospital death were older,had higher Gensini score,creatinine concentration,and MPV,and had lower HDL cholesterol concentration.MPV,age,HDL cholesterol concentration,creatinine concentration,and Gensini score were found to be independent predictors of in-hospital death.Conclusion:These results suggest that high admission MPV levels are associated with increased in-hospital mortality in geriatric patients with STEMI undergoing primary PCI.
基金supported by National Key Technology R&D Program in the "Twelfth Five-Year" Plan of China(2011BAI11B07)
文摘Background: This study evaluated the effect of omeprazole or pantoprazole on platelet reactivity in non-STsegment elevation acute coronary syndrome(NSTE-ACS) patients receiving clopidogrel.Methods: Consecutive patients with NSTE-ACS(n =620) from general hospital of Shenyang Military Command were randomized to the omeprazole or pantoprazole(20mg/d) group(1:1), and received routine dual antiplatelet treatment. Patients' reversion rate of adenosine diphosphate-induced platelet aggregation(ADP-PA) was assessed at baseline, 12 to 24 h after administration of medication, and after 72 h of percutaneous coronary intervention(PCI). The primary endpoint of the study was platelet reactivity assessed with ADP-PA at 30 days after PCI. Adverse events(AEs) were recorded for 30-day and 180-day follow-up periods.Results: There were no significant differences between both the groups in platelet response to clopidogrel at 12–24h after drug administration(54.09%±18.90% vs. 51.62%±19.85%, P=0.12), 72 h after PCI(52.15%±19.45% vs. 49.66%±20.05%, P=0.18), and 30 days after PCI(50.44%±14.54% vs. 48.52%±15.08%, P=0.17). The rate of AEs did not differ significantly between groups during the 30-day(15.2% vs. 14.8%, P=0.91) and 180-day(16.5% vs. 14.5%, P=0.50) follow-up periods after PCI.Conclusion: The addition of omeprazole or pantoprazole to clopidogrel did not restrict the effect of platelet aggregation by reducing the conversion of clopidogrel. Compared with clopidogrel alone, pantoprazole-clopidogrel and omeprazoleclopidogrel combinations did not increase the incidence of adverse clinical events during 30-day and 180-day follow-up periods after PCI.
文摘BACKGROUND The de Winter electrocardiography(ECG)pattern is a sign that implies proximal left anterior descending coronary artery occlusion in patients with chest pain.The previous view was that the de Winter ECG pattern is static.CASE SUMMARY A 65-year-old man presented with sudden chest pain at rest associated with diaphoresis for 55 min.The first ECG showed only T-wave inversion in III and aVF leads.Another ECG was performed at the 100th minute,showing upsloping ST segments depressed with tall and symmetrical T waves in the precordial leads;the J point was raised by 0.1 mV at the aVR lead.The patient was referred to our catheterization laboratory.A third ECG showed ST segment elevation by 0.2 mV in the I and aVL leads.The patient underwent emergency coronary angiography,which revealed complete proximal left anterior descending coronary(LAD)occlusion.The second patient presented with a 1-h history of sudden-onset,severe,substernal crushing chest pain.The first ECG showed STsegment elevation(0.1–1.7 mV)in I,aVL,and precordial leads.The patient was referred to the catheterization laboratory.On arrival,his symptoms alleviated,and ECG showed that the ST-segments had significantly fallen back.The third ECG showed a typical de Winter pattern.Coronary angiography revealed 99%stenosis of the middle LAD.CONCLUSION The de Winter ECG pattern is transient and dynamic,and it reflects proximal or mid-LAD subtotal occlusion rather than total occlusion.
文摘BACKGROUND Myocardial infarction,particularly ST-segment elevation myocardial infarction(STEMI),is a key global mortality cause.Our study investigated predictors of mortality in 96 STEMI patients undergoing primary percutaneous coronary intervention at Erbil Cardiac Center.Multiple factors were identified influencing in-hospital mortality.Significantly,time from symptom onset to hospital arrival emerged as a decisive factor.Consequently,our study hypothesis is:"Reducing time from symptom onset to hospital arrival significantly improves STEMI prognosis."AIM To determine the key factors influencing mortality rates in STEMI patients.METHODS We studied 96 consecutive STEMI patients undergoing primary percutaneous coronary intervention(PPCI)at the Erbil Cardiac Center.Their clinical histories were compiled,and coronary evaluations were performed via angiography on admission.Data included comorbid conditions,onset of cardiogenic shock,complications during PPCI,and more.Post-discharge,one-month follow-up assessments were completed.Statistical significance was set at P<0.05.RESULTS Our results unearthed several significant findings.The in-hospital and 30-d mortality rates among the 96 STEMI patients were 11.2%and 2.3%respectively.On the investigation of independent predictors of in-hospital mortality,we identified atypical presentation,onset of cardiogenic shock,presence of chronic kidney disease,Thrombolysis In Myocardial Infarction grades 0/1/2,triple vessel disease,ventricular tachycardia/ventricular fibrillation,coronary dissection,and the no-reflow phenomenon.Specifically,the recorded average time from symptom onset to hospital arrival amongst patients who did not survive was significantly longer(6.92±3.86 h)compared to those who survived(3.61±1.67 h),P<0.001.These findings underscore the critical role of timely intervention in improving the survival outcomes of STEMI patients.CONCLUSION Our results affirm that early hospital arrival after symptom onset significantly improves survival rates in STEMI patients,highlighting the critical need for prompt intervention.
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Background Non-ST-segment elevation acute coronary syndrome （NSTE-ACS） is an acute heart disease caused by incomplete occlusion of related coronary arteries with unstable atherosclerotic plaques. Lead aVR ST- segment elevation and cTnI positive are closely correlated to the prognosis of NSTE-ACS patients. However, there are few studies applying the two predictors to early risk stratification in NSTE-ACS patients. Method Two hundred and five cases of NSTE-ACS patients followed up for 6 months after discharge were reviewed. All patients were divided into four groups： Group A-cTnI negative combined with aVR-non-ST-segment elevation group （100 cases） ; Group B-cTnI negative combined with aVR-ST-segment elevation group （31 cases） ; Group C-cTnI positive combined with aVR-non-ST-segment elevation group （43 cases） ; Group D-cTnI positive combined with aVR-ST-segment elevation group （31 cases）. There was no significant difference in gender, age, old myocardial infarction, previous PCI history, hypertension, and diabetes between aVR-ST elevation group and no aVR-ST elevation group. The morbidity of left main or three-vessel coronary artery disease as well as adverse cardiovascular events in the four groups were observed and analyzed. Results （i） The morbidity of left main or three-vessel coronary artery disease was highest in Group D （87.1%） , and was markedly higher in Group B （41.9%） than that in Group A （7%） or Group C （9.3%） ; （ii） The incidence of adverse cardiovascular events was highest in Group D （77.4%）, and was much higher in B （35.5%） as compared with that tin Group A （1%） or group C （7%）. Conclusion Electrocardiographic lead aVR ST-segment elevation combined with cTnI positive has an important clinical value in predicting the prognosis of the patients with NSTE-ACS.
文摘To investigate the value of N-terminal prohormone brain natriuretic peptide （NT-proBNP） in the evaiuation of the coronary artery condition （ degree of the coronary artery lesion severity and complexity） in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Eighty patients with STEMI diagnosed by electrocardiogram （ECG） were selected. The concentration of plasma NT-proBNP was measured by electrochemiluminescence immunoassay, and the value of NT-proBNP concentration to evaluate the degree of severity and complexity in coronary artery lesion by coronary angiography （CAG） was analyzed. Results The more serious and more complex of coronary artery lesion in patients with ST-segment elevation myocardial infarction, the higher the concentration of plasma NT-proBNP was （ P 〈 0. 05 ）. Conclusion The concentration of plasma NT-proBNP may be a useful marker to evaluate the degree of severity and complexity of coronary artery lesion in patients with ST-segment elevation myocardial infarction. （ S Chin J Cardiol 2009 ; 10 （ 1 ） ： 15-18）
文摘A 53 years old female patient with hypertension presented with constrictive retrosternal chest pain. Initial Electrocardiogram (ECG) showed ST elevation in aVR and high level cardiac Troponin-I. Thrombolysis with streptokinase was performed and she underwent?coronary angiography who showed a long tight anterior inter ventricular lesion, occlusion of the proximal circumflex and an intermediate lesion of segment 2 of the right coronary.
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.
