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Objective:To examine the predictive value of the intra-aortic balloon counterpulsation-shock Ⅱ(IABP-SHOCK Ⅱ)score for 30-day mortality of acute myocardial infarction(AMI)complicated by cardiogenic shock(CS)in elderly patients.Methods:Clinical data of 138 elderly patients with AMI complicated by CS admitted to our hospital and undergone IABP from January 2010 to January 2019 were retrospectively analyzed.According to the IABP-SHOCK Ⅱ score, they were divided into a low-risk group(scoring 0 to 2 points, 72 cases), a middle-risk group(scoring 3 to 4 points, 39 cases)and a high-risk group(scoring 5 to 9 points, 27 cases). Baseline data, drug therapy, interventional therapy, and IABP were used in the three groups.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of IABP-SHOCK Ⅱ for 30-day mortality.Results:Of the 138 patients, 71(51.4%)were male.There were significant differences in age, left ventricular end-diastolic diameter, left ventricular ejection fraction, levels of troponin, serum creatinine, urea nitrogen, B-type natriuretic peptide and lactic acid, Gensini score, rate of thrombolysis in myocardia infarction(TIMI)no-reflow, and rates of IABP insertion, invasive ventilation and bedside hemofiltration between the intermediate-risk group and the low-risk group and between the high-risk group and the low-risk group(each P<0.05). During hospitalization, proportions of patients receiving vasoactive drugs such as norepinephrine and dopamine in the three groups were similar(each P>0.05). After 30 days of follow-up, 25 patients(34.7%), 20 patients(51.3%), and 23 patients(85.2%)died in the low-risk group, the intermediate-risk group, and the high-risk group, respectively, with the Kaplan-Meier survival curve and the log-rank test showing statistically significant differences between the death rates(χ2=20.09, P<0.01). The ROC curve showed that the area under the curve was 0.883(95% CI: 0.702~0.942, P<0.01). Conclusions:The IABP-SHOCK Ⅱ score may be used for short-term risk stratification after IABP implantation in elderly patients with AMI and CS.
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Objective To investigate the short-term clinical effect of extracorporeal membrane oxygenation(ECMO) for elderly patients with acute myocardial infarction(AMI)complicated with cardiogenic shock and to analyze its risk factors.Methods Clinical data of 55 elderly patients with AMI complicated with cardiogenic shock admitted into Henan Provincial Chest Hospital from January 2011 to July 2018 were retrospectively analyzed.According to the prognosis,patients were divided into the survival group (n =41) and the death group (n =14).Baseline characteristics were compared between the two groups.The short-term prognosis during hospitalization including use of temporary pacemaker,continuous renal replacement therapy and ventilation treatment and complications were compared.Univariate and multivariate logistic regression analysis were used to assess the risk factors for mortality.Results Of the 55 patients,30 patients were male(54.5％),with a mean ±SD age of (67.2±5.3)years.The time from admission to ECMO insertion was(8.6 ± 6.3)h,and the support time was (143.2 ± 61.7) h.There were significant differences in diabetes incidence,hemodynamic indexes,renal function,troponin,B-type natriuretic peptide,lactate levels and the Acute Physiology and Chronic Health Enquiry (APACHE-Ⅱ) score between the two groups (P ＜ 0.05).The dosage of norepinephrine,dobutamine and other vasoactive agents,and the application frequency of continuous renal replacement therapy,invasive ventilation treatment and intra-aortic balloon counterpulsation during hospitalization were increased in the death group compared with the survival group(P＜0.05) Incidence rates of complications including acute kidney injury,infection and multiple organ dysfunction syndrome were higher in death group than in survival group(P＜0.05).Multiple logistic regression analysis showed that advanced age,low left ventricular ejection fraction (LVEF),acute kidney injury,infection and multiple organ dysfunction syndrome were risk factors for the short-term mortality(P＜0.05).Conclusions The prognosis of elderly patients with AMI complicated with cardiogenic shock are poor.ECMO can significantly improve the hemodynamic indexes,but has no effect on the survival time in elderly patients with AMI complicated with cardiogenic shock.The advanced age,low LVEF,acute kidney injury,infection and multiple organ dysfunction syndrome are risk factors for the short-term mortality.
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Objective To evaluate the short-term safety,efficacy and prognosis of different antithrombotic therapy regimens in elderly patients with atrial fibrillation after coronary artery stenting.Methods A total of 272 atrial fibrillation patients with 121 males and a mean age of(67.1 ±5.2)years undergoing coronary artery stenting in our hospital from January 2013 to December 2015 were retrospectively analyzed and rondomized into two antithrombotic therapy regimens:a dual antiplatelet therapy with aspirin and clopidogrel(DT group,n=175)and a triple antithrombotic therapy with warfarin,aspirin and clopidogrel(TT group,n=97).The one-year risk of major bleeding and major adverse cardiac and cerebrovascular event (MACCE) were compared between two groups.Results After one year follow-up,the rate of major bleeding was lower in the DT group (0.6％,n=1)than in the TT group(5.2％,n=5)(x2 =5.92,P =0.01).Nevertheless,the rates of MACCE showed no statistical difference between two groups (all P ＞ 0.05).No statistically significant differences were found between DT group(n=175)and TT group(n=97)in six therapeutic efficacy indexes as the follow[n(％)in DT vs.n(％)in TT]:in in-stent thrombosis[1 (0.6)in DT vs.0 (0.0) in TT],in myocardial infarction relapse [35 (20.0) in DT vs.17 (17.5) in TT],in revascularization once more[28(16.0)in DT vs.17(17.5)in TT],in death[7(4.0)in DT vs.3(3.1)in TT],in adverse cardiac cerebrovascular events[90 (51.4) in DT vs.45 (46.4) in TT],and in ischemic stroke[19(10.9) in DT vs.8 (8.2) in TT] (all P ＞ 0.05).However,the rate of atrial fibrillationinduced ischemic stroke may be increased in patients treated with DT of aspirin and clopidogrel as compared with TT of warfarin,aspirin and clopidogrel.Conclusions For atrial fibrillation after coronary artery stenting,triple antithrombotic treatment can lead to increased risks for major bleeding with similar rate of MACCE to dual antiplatelet therapy,but dual antiplatelet therapy may result in the raised rate of atrial fibrillation induced ischemic stroke.
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@#Objective To assess the clinical safety and effectiveness of Boomerang closure device (Boomerang Percutaneous Femoral Access Management System) applied to patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).Methods206 patients undergoing CAG and/or PCI were randomly divided into the heparin group and low molecular heparin (LWMH) group. The hemostasia success rate, hemostasia time, manual pressure time, device dwell time, complication rate and time to ambulation with each other of two groups were compared.ResultsThe heparin group and LWMH group both had high hemostasia success rate (98.06% and 99.03%), there wasn't significant difference between two groups. There was one patient with hematoma formation in the heparin group and LWMH group respectively. There was no significant difference between two groups in hemostasia time, manual pressure time, the device dwell time and time to ambulation.ConclusionAfter CAG and/or PCI, administered heparin and low molecular heparin is no effect on Boomerang closure device, and Boomerang closure device has a high hemostasia success rate.