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Objective To investigate the prognostic risk factors of patients with acute inferior myocardial infarction and intra-operative occurrence of ventricular fibrillation (VF) when undergoing emergency percutaneous coronary intervention (PCI). Methods The data of 52 patients with acute inferior myocardial infarction treated in Cangzhou City People's Hospital from May 2016 to May 2018 were retrospectively analyzed, and they were divided into poor prognosis group (19 cases) and good prognosis group (33 cases) according to whether cardiovascular events occurred during 1 year of follow-up. The patients' gender, age, smoking or not, histories of diabetes, hypertension, hyperlipidemia, and the results of well performed color echocardiography within recent 3 days, such as left ventricular ejection fraction (LVEF), cardiac infarction size (IS), and coronary Gensini score were recorded in the two groups; the indicators with statistical significance in univariate analysis were included in the multivariate logistic regression analysis to screen out the prognostic risk factors of patients with acute inferior wall myocardial infarction undergoing emergency PCI and occurrence of intra-operative VF; Receiver operating characteristic (ROC) curve was drawn to evaluate the values of coronary Gensini score and IS in predicting intraoperative occurrence of VF in patients with acute inferior wall myocardial infarction undergoing emergency PCI. Results During 1-year follow-up, 19 of 52 patients with acute inferior myocardial infarction occurred VF, the incidence being 36.5%. The univariate analysis showed that the IS and Gensini score in poor prognosis group were significantly higher than those in the good prognosis group [IS: (3.2±0.2)% vs. (2.5±0.4)%, Gensini score: 98.8±12.5 vs. 85.7±8.4, both P < 0.05], the LVEF level was significantly lower in the poor prognosis group than that in the good prognosis group (0.37±0.08 vs. 0.46±0.11, P < 0.05). The multivariate Logistic regression analysis showed that IS [odds ratio (OR) = 5.016] and coronary Gensini score (OR = 2.415) were the risk factors of occurrence of cardiovascular events after surgery in patients with acute inferior myocardial infarction and intra-operative VF when undergoing PCI (P < 0.05). The ROC curve analysis showed that IS and coronary Gensini scores had certain predictive values for the prognosis of patients with acute inferior myocardial infarction and occurrence of intra-operative VF when undergoing emergency PCI, the area under the ROC curve (AUC) was 0.863 and 0.597, respectively, indicating that IS had a medium predictive value, while the value of coronary Gensini score was lower, when the IS optimal cut off value was 3.0, the sensitivity was 89.4% and the specificity was 88.0%. Conclusion High IS and Gensini score are the risk factors of prognosis of patients with acute inferior myocardial infarction and intra-operative occurrence of VF when undergoing emergency PCI.
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Objective To explore the possible causative factors of appearance of ventricular fibrillation (VF) during emergency percutaneous coronary intervention (PCI) in patients with acute inferior myocardial infarction. Methods Five hundred and seventy two patients with acute inferior myocardial infarction who underwent emergency PCI 24 hours after onset from May 2016 to May 2018 in Cangzhou People's Hospital were enrolled, they were divided into a VF group (52 cases) and a non-VF group (NVF, 520 cases) according to whether VF occurred or not during PCI. The differences in clinical data, characteristics of coronary artery disease and coronary artery score (Gensini score) between the two groups were compared; multivariate Logistic regression analysis was used to analyze the risk factors related to the occurrence of VF during emergency PCI; the receiver operating characteristic curve (ROC) was drawn to evaluate the efficacy of each risk factor. Results There were no statistical significant differences in sex, age, past histories of drinking alcohol, smoking, hypertension, diabetes, previous use of β blockers, aspirin, the peak values at admission of systolic blood pressure, heart rate, creatine kinase isoenzyme (CK-MB) and cardiac troponin I (cTnI), etc between the two groups (all P > 0.05). The proportions of patients with grade 0 blood flow in myocardial infarction thrombolysis (TIMI) before recanalization, with high thrombus load, criminal vessels being right coronary artery (RCA) and proximal segment of RCA, Gensini score in VF group were significantly higher than those in NVF group [TIMI 0: 80.8% (42/52) vs. 58.1% (302/520), high thrombus load: 71.2% (37/52) vs. 58.1% (302/520), criminals being RCA: 84.6% (44/52) vs. 73.7% (383/520), the occlusion site of infarction-related artery (IRA) being the proximal segment of RCA: 61.5% (32/52) vs. 41.2% (214/520), Gensini scores: 93.84±16.48 vs. 61.37±20.01, all P < 0.05]. The multiple logistic regression analysis showed that the risk factors for VF occurrence during emergency PCI for patients with acute inferior myocardial infarction included the criminals being RCA [odds ratio (OR) = 1.967, 95% confidence interval (95% CI) = 1.696-3.015, P =0.032], TIMI blood flow grade 0 before re-canalization (OR = 3.032, 95%CI = 1.248-3.675, P = 0.043), the occlusion site of infarction-related artery (IRA) being the proximal segment of RCA (OR = 2.288, 95%CI = 1.458-3.895, P =0.024), Gensini score (OR = 6.558, 95%CI = 2.168-13.359, P = 0.001] and high thrombus load (OR = 1.781, 95%CI =1.016-3.017, P = 0.033); they all were risk factors of occurrence of ventricular fibrillation during emergency PCI in patients with acute inferior myocardial infarction (all P < 0.05). ROC curve analysis showed that TIMI blood flow grade 0 before re-canalization, Gensini score and higher thrombus load had certain predictive value for VF occurrence during emergency PCI for acute inferior wall myocardial infarction; the area under ROC curve (AUC) was 0.613, 0.869 and 0.605, and 95% CI was 0.540-0.687, 0.787-0.969 and 0.521-0.675, the P value was 0.007, 0.000 and 0.012, respectively, suggesting that Gensini score had moderate predictive value for intra-operative VF, while the predictive values of TIMI blood flow grade 0 before re-canalization and higher thrombus load were relatively low. When the Gensini score had an optimal cutoff value of 96.50, the sensitivity was 85.50% and the specificity was 81.20%. Conclusion The risk factors of VF occurrence in emergency PCI for patients with acute inferior myocardial infarction are criminal vessel RCA, TIMI blood flow grade 0 before re-canalization, IRA occlusion site being proximal segment of RCA, Gensini score and high thrombus load; pre-recanalization TIMI blood flow grade 0, Gensini score and higher thrombus load all have certain predictive value for the occurrence of VF in emergency PCI for acute inferior myocardial infarction.
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Objective To investigate the preoperative risk factors of occurrence of intra-operative ventricular fibrillation (VF) in patients with acute inferior myocardial infarction undergoing emergency percutaneous coronary intervention(PCI). Methods A retrospective approach was conducted, 572 patients with acute inferior myocardial infarction admitted to Cangzhou City People's Hospital from May 2016 to May 2018 were enrolled, and they were divided into VF group (50 cases) and non-VF group (520 cases) according to whether the intra-operative complication of VF occurred. The clinical data of the two groups of patients were collected, and the related risk factors were analyzed by univariate and multivariate analyses to explore the preoperative risk factors related to VF intra-operative occurrence in patients with acute inferior myocardial infarction undergoing emergency PCI; the receiver operating characteristic (ROC) curve was drawn to evaluate the test efficiencies of all kinds of risk factors. Results The univariate analysis showed that the ratio of Killip > Ⅰ grade, infarct area size/blood potassium concentration (IS/[K]) and symptom onset to balloon dilatation time (SOTBT) in the VF group were significantly higher than those in the non-VF group [Killip > Ⅰ grade:36.5% (19/52) vs. 24.0% (125/520), IS/[K]: 3.2±0.3 vs. 2.5±0.8, SOTBT (hours): 6.3 (2.1, 8.0) vs. 4.6 (1.8, 6.5)], the differences were statistically significant (all P < 0.05); the T wave peak to T end interval/QT interval (Tp-e/QT) and blood potassium level of the VF group were significantly lower than those of the non-VF group [Tp-e/QT: 0.3±0.1 vs. 0.4±0.1; blood potassium (mmol/L): 2.8±0.5 vs. 4.1±1.2, both P < 0.05]. Multivariate logistic regression analysis showed that the SOTBT > 6 hours [odds ratio (OR) = 8.337], Killip >Ⅰ grade (OR = 1.721), hypokalemia (OR = 1.031) and high IS/[K] (OR = 9.167) were independent risk factors for intra-operative occurrence of VF in patients with acute inferior myocardial infarction during emergency PCI (all P < 0.05). ROC curve analysis showed that the area under the ROC curve (AUC) of serum potassium, IS/[K], SOTBT > 6 hours and Killip > Ⅰ grade for predicting the intra-operative occurrence of VF during emergency PCI for patients with acute inferior myocardial infarction had certain values, their AUC were 0.633, 0.837, 0.821, 0.682, respectively, suggesting that IS/[K] and SOTBT > 6 hours had moderate predictive values, and serum potassium, Killip > Ⅰ grade had relatively low predicative values; when the optimal cut-off value of IS/[K] was 2.8, the sensitivity was 85.5% and the specificity was 80.0%. Conclusion SOTBT > 6 hours, Killip > Ⅰ grade, hypokalemia, and high IS/[K] are independent risk factors of intra-operative occurrence of VF in patients with acute inferior myocardial infarction undergoing emergency PCI.
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Objective To explore the effect of atorvastatin application on serum ferritin(SF)levels in elderly male patients with acute coronary syndrome(ACS)and its clinical significance. Methods 120 elderly male patients treated in Department of Cardiology in Cangzhou People's Hospital were randomly divided into treatment group and control group(60 cases in each group). All the patients in the two groups took the standard treatment of coronary heart disease,and the patients in treatment group were additionally given atorvastatin 20 mg orally,once-daily for 1 month. After 1 month of treatment,the changes in SF and lipid levels before and after treatment were determined. Results The total cholesterol(TC),low density lipoprotein(LDL)and SF levels of the two groups after treatment were significantly decreased compared with those before treatment. After treatment,triacylglycerol (TG)was decreased,and high-density lipoprotein(HDL)was increased significantly in treatment group,while in the control group,after treatment TG was increased and HDL was decreased. Compared between treatment and control groups after treatment,the differences in SF,TC,TG,HDL and LDL levels were statistically significant〔SF(μg/L):174.33±99.87 vs. 255.66±100.34,TC(mmol/L):4.23±0.60 vs. 5.15±0.56,TG(mmol/L):1.98±0.64 vs. 2.00±1.03,HDL(mmol/L):1.13±0.14 vs. 1.09±0.22,LDL(mmol/L):2.45±0.33 vs. 3.35±0.50,P<0.05 or P<0.01〕. Conclusion In elderly male hospitalized patients with ACS,the level of SF is significantly higher than normal,after atorvastatin specification treatment,the blood fat and SF levels are significantly lower,thus the SF inducing myocardial damage may be reduced and the risk of recurrence of acute coronary events can be decreased.
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Objective To investigate the relationships between level of serum ferritin(SF)/blood lipid and the degree of coronary artery stenosis in elderly patients with acute coronary syndrome(ACS),and evaluate the value of SF in the diagnosis of coronary heart disease. Methods ①One hundred and twenty-five elderly patients with ACS(65 males,60 females)underwent coronary angiography examination,and the total cholesterol(TC), triglycerides(TG),high-density lipoprotein(HDL-C),low density lipoprotein(LDL-C)and SF were determined;according to the results of coronary angiography,the degree of coronary artery stenosis was obtained by using the Gensini score and the degrees of severity of stenosis were divided into three groups:light(42 cases),medium (45 cases)and severe(38 cases). The differences in levels of SF and blood lipids among the three groups were observed,and the relationships between the level of SF/blood lipids and various degrees of coronary artery stenoses were analyzed.②The elderly patients with ACS were divided into two groups,male and female,to compare the SF numerical value and Gensini score between the two groups. ③The SF numerical value and Gensini score of 65 senile male cases with ACS were compared to those of 60 middle aged male cases with the same disease. Results ①Variance analysis showed that SF,TC,LDL-C distribution had significant differences among light,medium and severe groups〔SF(μg/L):147.287±73.838,162.313±94.882,290.421±194.501;TC(mmol/L):4.423±0.900,4.998±0.740, 5.032±1.009;LDL-C(mmol/L):3.150±0.799,3.439±0.839,3.902±1.053,all P0.05);in elderly patients with ACS,SF was positively correlated with Gensini score(r=0.355,P=0.000),while there was no correlation between Gensini score and any one of the following lipids:TC,TG,LDL-C,HDL-C(r=0.090,-0.170,0.256,-0.060,P=0.532,0.092,0.089,0.537).②The comparisons of SF value and Gensini score between senile male and senile female patients with ACS showed no significant differences(all P>0.05).③The comparisons of SF value and Gensini score between senile and middle aged male patients with ACS also showed no significant differences(all P>0.05). Conclusion The occurrence of ACS has certain correlation with SF and lipids,the degree of severity in coronary artery lesion is associated with SF,and there are no differences in age and sex in relation to the value of SF in the diagnosis of ACS.