ABSTRACT
Objective To investigate the clinical symptoms and pathogeny of acute myocardial infarction (AMI) in emergency normal coronary angiography ( CAG). Methods From October 2015 to October 2017,the clinical data of 207 AMI patients withemergency CAG in the First People's Hospital of Huainan were retrospectively analyzed,including 7 patients with normal CAG. The clinical symptoms and pathogeny of these patients were analyzed. Results Among the patients with AMI,the patients with normal CAG accounted for 3. 38 ％ (7 / 207),the average age was (49. 00 ± 11. 94)years old,4 patients were men,3 patients were smokers and 3 patients had hypertension. The results of laboratory examination were cTnI (7. 81 ± 4. 32)μg/ L,myoglobin (231. 43 ± 136. 03)μg/ L,CK - MB (15. 3 ± 4. 63)μg/ L. The pathogeny of these patients were one case with coronarospasm(14. 29 ％ ),one case with myocardial bridge(14. 29％ ),two cases with intracoronary thrombolysis(28. 57％ ),two cases with aortic dissection (28. 57％ ),and one case with myocarditis(14. 29％ ). In addition to aortic dissection in 1 case of death,1 case was transferred outside,the rest of the patients discharged after hospitalization. Conclusion AMI mainly occurres because of vascular thrombosis caused by the unstable coronary atherosclerosis plaque rupture,but some patients with normal CAG can also occure AMI,it has different clinical characteristics and pathogenys. In practice it should be carefully identified in order to improve the cure rate and prognosis.
ABSTRACT
Objective: To assess the clinical significance of peripheral blood levels of erythrocyte micro-particles on acute coronary syndrome (ACS) diagnosis. Methods: A total of 150 patients treated in our hospital from 2015-01 to 2016-09 were enrolled in this study. The patients were divided into 2 groups: Non-CAD (coronary artery disease) group, n=45 and ACS group, n=105. ACS group was further divided into 3 subgroups: STEMI (acute ST-segment elevation myocardial infarction) subgroup, n=37, Non-STEMI subgroup, n=31 and UAP (Unstable angina pectoris) subgroup, n=37. Peripheral blood sample was collected, erythrocyte micro-particles were separated by Ca2+ vector A23187 method and relevant micro-particles were labeled by specific antibody (glycophorine A) for qualitative and quantitative flow cytometry analysis. Results: Compared with Non-CAD group, ACS group had the higher peripheral level of erythrocyte micro-particles [％, 26.20 (15.90, 38.00) vs 14.00 (4.35, 36.35), P<0.05]. In ACS group, erythrocyte micro-particles were similar among 3 subgroups: in STEMI subgroup [％, 27.20 (17.25, 24.25)], in Non-STEMI subgroup [％, 21.50 (12.76, 34.90)] and in UAP subgroup [％, 30.20 (17.10, 39.65)], P>0.05. Conclusion: Peripheral blood levels of erythrocyte micro-particles were elevated in ACS patients which implied it may involve ACS development and could be related to acute thrombosis event in ACS patients.
ABSTRACT
Objective To summarize the echocardiographic findings and clinical characteristics of Kawasaki disease(KD) complicated with coronary artery thrombosis (CAT).Methods Thirty-five patients with KD combined with CAT were enrolled,who were admitted to Beijing Children's Hospital,Capital Medical University between July 2005 and August 2016.The clinical characteristics and echocardiographic findings during follow-ups were retrospectively studied.According to whether the childrenhad been complicated with myocardial ischemia,the patients were divided into 2 groups:ischemic group and non-ischemic group.The duration of fever,the time when the intravenous immunoglobulin(IVIG) was first injected,the time when coronary artery aneurysms (CAA) was formed,the maximum diameter of CAA and inflammatory index inthe acute phase were compared between 2 groups.Results All of the 35 children diagnosed as KD combined with CAT suffered firom CAA,and the coronary thrombosis was detected in all the cases with aneurysms.Thirty-five patients had 99 branches of CAA,of which the maximum diameter of CAA was (9.6 ± 3.1) mm(4.0-19.0 mm).Fifty-four plots of CAT were detected in the aneurysms.The diameter of CAA that thrombosis located was larger than that of which the thrombosis was not located[(10.9 ± 2.8) mm vs.(7.9 ± 2.6) mm],and the difference was significant(P ＜0.01).During 4 months to 10 years and 8 months [(39.2 ±29.5) months] follow-ups,CAA regressed in 32 branches [32.3％ (32/99 branches)],of which 4 branches [4.0％ (4/99 branches)] completely regressed to the normal diameter.The maximum diameter of CAA regressed was smaller than the maximum diameter of CAA consistence [(7.3 ± 1.9) mm vs.(10.6 ± 3.0) mm],and the difference was significant (P ＜ 0.01).Out of 35 patients,15 cases [42.9％ (15/35 cases) had myocardial ischemia,while the other 20 cases[57.2％ (20/35 cases)] didn't have.Among 15 cases with myocardial ischemia,6 cases[17.1％ (6/35 cases)] had myocardial infarction,4 cases [11.4％ (4/35 cases)] had heart failure,and 1 case[2.9％ (1/35 cases)] died of acute heart failure complicated with severe ventricular arrhythmia.Compared with non-ischemic group,the children in the ischemic group had longer duration of fever[(19.1 ± 7.8) d vs.(12.1 ± 3.3) d],higher white blood cell account in the acute phase[(24.8 ± 13.5) × 1012/L vs.(19.7 ±4.0) × 1012/L],later treatment of IVIG [(13.9 ± 5.5) d vs.(9.8 ±3.8) d],and earlier CAA formation [(16.0 ±4.9) d vs.(20.9 ± 14.5) d],and the differences were statistically significant (all P ＜ 0.05).Conclusions CAT of children with KD commonly originates from CAA.Patients who have more serious inflammatory reaction in the acute phase,earlier formation,heavy severity and longer consistence of CAA are prone to have myocardial ischemia.Echocardiographic study plays an important role in monitoring CAA,detecting the CAT and finding the early left ventricle dysfunction,which is of clinical significance.