ABSTRACT
Elderly adults constitute a rapidly increasing subgroup of patients presenting with acute coronary syndrome.Due to a higher risk of bleeding and more multiple complications in the elderly,the treatment of acute coronary syndrome is more conservative in these patients than in younger patients.The scarcity of evidence from randomized controlled trials makes antithrombotic therapy in elderly patients particularly challenging and controversial.This article reviews the current evidence on antithrombotic therapy for acute coronary syndrome in the elderly.
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Objective:To investigate reperfusion and secondary preventive drug therapy for ST-segment elevation myocardial infarction (STEMI) patients in provincial, city and county levels hospitals of China. Methods:A total of 18,967 STEMI patients within 7 days of symptom onset from 2013-01-01 to 2014-09-30 were enrolled by China acute myocardial infarction (CAMI) registry study group from 107 hospitals covering 31 provinces/autonomous regions, cities and counties in China;223 patients were excluded for key information missing. Demographic data, reperfusion as primary percutaneous coronary intervention (pPCI), thrombolytic therapy (TT) and secondary preventive drug therapy as aspirin, P2Y12 inhibitors, statins,β-blockers, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor antagonist (ARB) were analyzed and compared among 3 levels of hospitals. Results:There were 9,885/18,744 (52.7%) patients received reperfusion including 8,038 (42.9%) pPCI and 1,847 (9.9%) TT. Reperfusion rate in provincial hospital (61.8%, 4041/6537) was higher than city hospital (49.1%, 4728/9625) and county hospital (43.2%, 1116/2582), P Conclusion:In CAMI Registry, 70.8%arrived hospital within12 h of symptom onset had been treated by reperfusion therapy in China; the reperfusion rate in county hospital was obviously lower. The secondary preventive drug therapy condition was similar among 3 levels of hospitals.
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@#Objective To study the correlation between N-terminal pro-brain natriuretic peptide (NT-proBNP) and cardiac diastolic and systolic function. Methods 60 New Zealand male rabbits were randomly assigned to two groups. The abdominal aorta 1 cm just above right renal artery were constricted in operated group. The clinical manifestation of heart failure was observed, and cardiac structure and function were investigated with echocardiography. Concentration of serum NT-proBNP was determined regularly. Results The concentration of NT-proBNP was correlated with Sm（r=－0.635,P=0.000）, Em（r=－0.693,P=0.000）, E/Em（r=0.688,P=0.000）, E/Vp（r=0.707, P=0.000）, and EF（r=－0.395,P=0.001）. Conclusion Concentration of serum NT-proBNP could prognose the diastolic and long axis systolic function of left ventricle.
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@#Objective To establish an animal model of heart failure with preserved ejection fraction(EF)resulting from hypertension.Methods35 male New-Zealand rabbits were randomly assigned to 2 groups:constriction was performed at the abdominal aorta 1 cm just above right renal artery in operated group(n=25),and the sham-operated animals were taken as control group(n=10).The clinical manifestations of heart failure were followed up carefully.Systolic and diastolic function,and systemic hemodynamics were investigated with echocardiography and left ventricle catheter.ResultsIn operated group,marked ventricular hypertrophy was observed 2 weeks after operation.4 weeks after operation,the clinical manifestations of heart failure presented,and IVRT and LVEDP increased,and-dp/dt max decreased.Tissue doppler image indicated that e/a ratio of annulus of mitral valve decreased(P<0.05).However,EF and +dp/dt max were preserved.ConclusionThe operated animals presented the clinical manifestation of heart failure,and diastolic function of left ventricle injured,however,ejection fraction was preserved,which corresponded with the character of heart failure with preserved ejection fraction resulting from hypertension.