ABSTRACT
<p><b>OBJECTIVE</b>To explore the characteristics and therapies of patients with acute myocardial infarction (AMI) in Wuxi city, China.</p><p><b>METHODS</b>A network was established to obtain information of patients with AMI who were admitted to 9 designated hospitals between 2011 and 2012. A total of 1 714 patients were enrolled (1 334 males, 754 smokers, 1 076 hypertension, 270 hyperlipidemia and 398 diabetes) including 1 410 patients with acute ST-segment elevation myocardial infarction (STEMI) and 304 patients with acute non ST-segment elevation myocardial infarction (NSTEMI). Patients' characteristics, therapies, the incidence of major adverse cardiovascular events (MACEs) and all-cause mortality were analyzed.</p><p><b>RESULTS</b>(1) Medication therapy was as follows: antiplatelet therapy 98.3% (1 685 cases) , beta-blockers 59.1% (1 013 cases) , ACEI or ARB 67.6% (1 159 cases) , statins 98.1% (1 682 cases) , and nitrates 71.1% (1 218 cases) . Of the patients, 7.1% (132 cases) received temporary pacemakers, 34.0% (480 cases) with acute STEMI underwent reperfusion [direct PCI 18.4% (260 cases) and thrombolysis 15.6% (220 cases)]. (2) According to the hospital admission data, patients were divided into three groups: group A, transported to the hospital by ambulance (n = 361); group B, transported to the hospital by private vehicles (n = 1 318); and group C, AMI occurred in the hospital (n = 35). The median time of AMI onset to physician contact of the 3 groups was 178 min, 368 min, and 9 min, respectively. The median time from AMI onset to the first ECG was 181 min, 379 min, and 10 min, respectively. The median time from AMI onset to cardiology specialist consultation was 187 min, 431 min, and 69 min, respectively. AMI onset-to-physician contact, AMI onset-to-first ECG, and AMI onset-to-specialized treatment time was the shortest in group C, followed by group A and group B. For patients with STEMI underwent reperfusion therapy, the median AMI onset-to-reperfusion therapy time was significantly shorter in group A patients than group B patients [thrombolysis group: 224(171, 514) min vs. 378 (158, 785) min, PCI group: 318 (154, 674) min vs. 489 (143, 816) min, all P < 0.05]. (3) The total incidence of MACEs was 16.3% (279/1 714), the all-cause in-hospital mortality rate was 13.1% (224/1 714). According to the AMI onset-to-physician contact, patients were divided into 4 groups: <3 h, 3-6 h, 6-12 h, and >12 h. The incidence of MACEs [4.4% (23/517), 13.3% (60/451), 19.1% (77/404) and 34.8% (119/342),χ(2) = 114.36, P < 0.01] and all-cause in-hospital mortality rate [4.1% (21/517) , 10.4% (47/451), 18.6% (75/404), 23.7% (81/342), χ(2) = 84.36, P < 0.01] increased in proportion to the time of AMI onset-to-physician contact. Among STEMI patients, the incidence of MACEs [5.8% (15/260) , 12.3% (27/220) , 20.9% (194/930) ,χ(2) = 39.93, P < 0.01] and all-cause in-hospital mortality [1.5% (4/260) , 10.0% (22/220) , 18.2% (170/930) ,χ(2) = 50.90, P < 0.01] was the lowest in the primary PCI group, followed by thrombolysis group and was the highest in the early conservative treatment group.</p><p><b>CONCLUSIONS</b>Guideline is well followed in terms of drug treatments of AMI in this cohort, but only a small proportion of AMI patients in Wuxi received reperfusion therapy. There is a considerable out-of-hospital time delay for AMI patients in this cohort which is shorter in group A than in group B. All-cause in-hospital mortality and MACEs is the lowest in AMI patients underwent primary PCI.</p>
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , China , Cross-Sectional Studies , Myocardial Infarction , TherapeuticsABSTRACT
We investigated the association between myeloperoxidase gene -463G > A polymorphism and premature coronary artery disease (CAD) in two Chinese population samples: 229 patients and 230 controls. Genotypes were determined by ligase detection reaction-polymerase chain reaction sequencing and the grouping technique. We found lower frequencies of both the A/A genotype and the A allele in patients (p < 0.05). Multivariate logistic regression showed that the risk of premature CAD in subjects carrying the AA genotype was reduced by 83 percent in relation to individuals carrying the G/G genotype (OR = 0.172, 95 percent CI: 0.057-0.526, p = 0.002). Our results indicate that -463G > A polymorphism of the myeloperoxidase gene is associated with premature CAD in Chinese individuals, suggesting that the AA genotype is a protective factor against premature CAD.
ABSTRACT
BACKGROUND: Recent studies indicate that bone marrow messenchymal stem cells (MSCs) can repairinjured myocardium and improve cardiac functions. However, there are still no effective non-invasive methods to detect ventricular wall motion, survival status of transplanted cells, and microcirculation improvement after MSCsimplantation. OBJECTIVE: To detect the effects of MSCs implantation on the cardiac function of ischemic myoeardium and investigate changes of tissue acoustics characteristics by using integrated backscatter (IBS) and Doppler tissue imaging (DT1). DESIGN, TIME AND SETTING: Completely randomized grouping design, and randomized controlled study, which was carried out in the Department of Cardiology, Renmin Hospital of Wuhan University from December 2004 to June 2005 (important laboratory of 211 government). MATERIALS: Forty-eight male rabbits with irrespective of gender were used for study. Anti-troponin T (TnT) antibody was provided by Maxim Company, USA; anti-bromodeoxyuridine (BrdU) antibody by Sigma Company, USA; Sonos 5500 echocardiography by HP Company, USA.METHODS: Forty-eight rabbits were randomly divided into model group and implantation group. Model of myocardium infarction was created in rabbits by left anterior descending coronary artery (LAD) ligation. Three days after modeling, autologous bone marrow MSCs were injected into crossed myocardium between infarction and non-infarction regions based on 5 injected points.MAIN OUTCOME MEASURES: Indicators including ventricular size, ventricular wall thickness, and ejection fraction (EF) in the left ventricle (LV) were measured with routine echocardiography one day before myocardial infarction, two weeks after myocardial infarction, and four weeks after implantation. IBS and DTI might detect the anterior backscatter parameters (AII, or IB) and ventricular wall motion parameters (PPI, or CVIB) to calculate the average backscatter scores and backscatter cycle changes. DTI was used to measure peak systolic flow velocity (VS), peak early diastolic flow velocity (VE), and peak late diastolic flow velocity (VA) of the middle and basal segments of the anterior wall of left ventricle. Finally, animals were sacrificed by anesthesia, and myocardial infarction region was stained with 5-Brdu immunohistochemical staining, and anti-TnT staining. RESULTS: Twelve rabbits were excluded because of death after operation.① Echocardiography: Imaging of 36 rabbits were clear in 1 day before myocardial infarction, 2 weeks after myocardial infarction, and 4 weeks after implantation. The sizes and systolic function of LV in 36 rabbits were normal before operation. Two weeks after operation, the sizes of LV became larger, the anterior wall of LV became thinner, and systolic range became weaker even disappeared. EF, CVIB, Vs, and Ve were lower (P < 0.05) and All was higher in both groups than pre-operation (P < 0.05). Four weeks after implantation, compared with control group, left ventricular diastolic diameter (LVDd) was smaller and systolic range became larger, All descended. EF, Vs, Ve and CVIB increased (P < 0.05).② Myocardial immunohistochemical detection: Numerous of Brdu-labeled positive cells were scattered, and anti-TnT was positive, which clearly showed horizontal stria of myocardium. However, normal myocardium was negative. CONCLUSION: Bone marrow MSCs after implantation can survive in ischemic myocardium and improve cardiac function. IBS and DTI can real-timely and exactly detect functional changes of infarction myocardium after bone marrow MSCs implantation.