Comportamiento de la cardiopatía isquémica en una unidad de cuidados intensivos / Characteristics of ischemic heart disease in an intensive care unit

Introducción: La cardiopatía isquémica es frecuente, tiene diversas formas de manifestarse y predomina entre las enfermedades que motivan el ingreso de pacientes a unidades de emergencias, y que causan ingresos hospitalarios. Objetivo: Profundizar en el conocimiento de los pacientes con cardiopatía isquémica en una unidad de cuidados intensivos municipal. Método: Se realizó un estudio descriptivo y transversal, de 528 pacientes que ingresaron en la Unidad de Cuidados Intensivos del Hospital General Docente Orlando Pantoja Tamayo, Contramaestre, Santiago de Cuba, con diagnóstico de cardiopatías isquémicas, desde enero de 2016 hasta junio de 2019. Las variables utilizadas fueron: grupo de edades, sexo, diagnostico al ingreso, antecedentes patológicos personales, estadía y estado al egreso. Se utilizó el porcentaje para resumir la información, así como el test chi cuadrado para identificar asociación estadística. Resultados: Hubo predominio del sexo masculino y edades entre 60-70 y 36-59 años, fueron más frecuentes el infarto agudo de miocardio y la combinación de 3 o más factores de riesgo. El mayor número de fallecimientos se ocurrió en los primeros 3 días de admitidos y en pacientes con ventilación mecánica invasiva. Conclusiones: El comportamiento de las enfermedades cardiovasculares continúa siendo un gran problema de salud, aparece en edades cada vez más tempranas. En casos severos la mortalidad puede ocurrir en las primeras 72 h(AU)

Introduction: Ischemic heart disease is frequent, has different manifestation forms, and predominates among diseases leading to patient admission into emergency units and hospital admissions in general. Objective: To deepen the knowledge of patients with ischemic heart disease in a municipal intensive care unit. Method: A descriptive and cross-sectional study was carried out of 528 patients who were admitted into the intensive care unit of Orlando Pantoja Tamayo General Teaching Hospital in Contramaestre Municipality, Santiago de Cuba, with a diagnosis of ischemic heart disease, from January 2016 to June of 2019. The variables used were age group, sex, diagnosis at admission, personal pathological history, hospital stay, and status at discharge. We used percentage to summarize the information, as well as the chi-square test to identify statistical association. Results: There was a predominance of males and ages between 60-70 and 36-59 years. Acute myocardial infarction and the combination of three or more risk factors were more frequent. The highest number of deaths occurred in the first three days after admission and among patients with invasive mechanical ventilation. Conclusions: The characteristics of cardiovascular diseases continues to be a major health concern, as long as they are appearing at increasingly earlier ages. In severe cases, mortality can occur in the first seventy-two hours(AU)

Score Cadillac como predictor de muerte en pacientes con infarto agudo de miocardio sometidos a angioplastia / CADILLAC Risk Score as a Death Predictor in Patients with Acute Myocardial Infraction and Who Received Angioplasty

Introducción: El infarto de miocardio es una de las enfermedades que causa más muertes en el mundo. Estudios demuestran que, en pacientes con infarto agudo de miocardio, la reperfusión percutánea temprana (angioplastia) tiene mejores resultados que el tratamiento médico aislado en la función ventricular, la clase funcional y la mortalidad temprana y tardía. Objetivo: Predecir la muerte a corto plazo en pacientes con infarto agudo de miocardio sometidos a angioplastia. Métodos: Investigación retrospectiva de corte transversal, cuyos datos fueron recolectados de las historias clínicas en un Centro Cardiológico de Ecuador. La muestra estuvo conformada por 50 pacientes que reunieron los criterios de inclusión, cuyos datos fueron valorados por la escala Score Cadillac, utilizada como instrumento, tomando en cuenta la supervivencia a los treinta días posteriores al procedimiento. Resultados: La tasa de mortalidad a los 30 días fue del 22 por ciento, de los cuales el 32,3 por ciento pertenecieron al grupo de edad mayor a 65 años, los predictores de mortalidad que más influyeron fueron: la fracción de eyección del ventrículo izquierdo (FEVI) ; 40 por ciento (73,3 por ciento), el flujo final de trombólisis en infarto de miocardio (TIMI) < 2 (46,1 por ciento), la anemia (66,6 por ciento) y la presencia de insuficiencia cardiaca (42,3 por ciento). Conclusión: El Score Cadillac es un importante predictor de mortalidad. La anemia deberá ser tomada en cuenta como predictor de mortalidad(AU)

Introduction: Myocardial infarction is one of the diseases that cause the most deaths worldwide. Studies show that, in patients with acute myocardial infarction, early percutaneous reperfusion (angioplasty) has better outcomes than isolated medical treatment in ventricular function, functional class, and early and late mortality. Objective: To predict short-term death in patients with acute myocardial infarction who have been received angioplasty. Methods: Retrospective and cross-sectional research, whose data was collected from medical records at a cardiology center in Ecuador. The sample consisted of 50 patients who met the inclusion criteria, whose data were assessed according the CADILLAC risk score, used as an instrument, taking into account survival at thirty days after the procedure. Results: The mortality rate at 30 days was 22 percent, of which 32.3 percent belonged to the age group over 65 years. The most influential mortality predictors were left ventricular ejection fraction (LVEF) under 40 percent (73.3 percent), final flow of thrombolysis in myocardial infarction (TIMI) under grade 2 (46.1 percent), anemia (66.6 percent), and the presence of heart failure (42,3 percent). Conclusion: The CADILLAC risk score is an important predictor for mortality. Anemia should be taken into account as a mortality predictor(AU)

Tendencias y características de la Mortalidad por Infarto Agudo al Miocardio en Costa Rica de 1970 al 2014 / Trends and characteristics of Acute Myocardial Infarction Mortality in Costa Rica from 1970 to 2014

Resumen Objetivo: analizar las principales características epidemiológicas de la mortalidad por infarto del miocardio en Costa Rica de 1970 al 2014. Métodos: los datos del número de muertos por IAM para todas las edades y de la población del país se obtuvieron consultando anuarios y bases de datos del Instituto Nacional de Estadística y del Centro de Población de la Universidad de Costa Rica (UCR). Con ellos se obtuvieron las tasas brutas y estandarizadas, "suavizadas" por promedios móviles y quinquenales, así como la relación porcentual con la mortalidad general. Posteriormente, se calcularon las tasas estandarizadas de mortalidad por IAM para el grupo de 35 a 74 años, por sexo y provincia. Resultados: la tendencia permite distinguir dos épocas definidas. Una de ascenso que ocurre desde 1970 hasta finales de la década de los años noventa. La otra en los primeros años del siglo XXI con inclinación hacia el descenso. Esto se observa con las tasas de promedios móviles y quinquenales, especialmente en el grupo de 35 a 74 años (hombres, r=0.99, r2=094, betha=-6.67, p=0.00, mujeres r=0.97, r2=0.94, betha= -6.67, p=0.01, ambos sexos r=0.97, r2=0.94, betha=-7.42, p=0.01). Conclusiones: pese a una leve tendencia a la disminución de la mortalidad por IAM en estos últimos quince años, el IAM continuará siendo un grave problema de salud en Costa Rica y para revertir la situación, tendrá el gobierno nacional que continuar esforzándose en disminuir la prevalencia de los principales factores de riesgo de las ECNT y en mejorar la atención del paciente que tiene la enfermedad.

Abstract Objective: To analyze the mortality and some aspects of the descriptive epidemiology of acute myocardial infarction in Costa Rica from 1970 to 2014. Methods: The number of deaths due to AMI for all ages and the population of the country were obtained through the consultation of yearbooks and the databases of the National Institute of Statistics and the Population Center of the UCR. With them gross and standardized rates were extracted, "smoothed" by moving and five-year averages as well as the percentage relation with the general mortality. Subsequently, the standardized mortality rates for AMI were obtained for the group of 35 to 74 years, according to sex, provinces and socioeconomic regions. Results: The analysis of the trend allows to distinguish two very well-defined periods. One of ascent that happens from 1970 until the end of the decade of the nineties. The other appears with the first years of the 21st century with a clear tendency towards descent. This is observed in the case of rates with moving and five-year averages and very especially, with the group of 35 to 74 years (men, r = 0.99, r2 = 0.94, betha = -6.67, p = 0.00, women r = 0.97, r2 = 0.94, betha = -6.67, p = 0.01, both sexes r = 0.97, r2 = 0.94, betha = -7.42, p = 0.01). Conclusions: Despite a slight tendency to decrease mortality from AMI in the last fifteen years, AMI will continue to be a serious health problem in Costa Rica and to reverse the situation, the national government will have to continue striving to reduce prevalence. of the main risk factors of NCDs and in improving the care of patients who have the disease.

Takotsubo cardiomyopathy complicating a twin pregnancy at partum

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Role of serum phosphate level in cardiovascular events in non-CKD patients

Background: Serum phosphate level correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease and coronary calcification is a known impact of higher serum phosphate, but whether this relationship exists among individuals with Non-CKD is unknown. we conducted this study to observe role of higher serum phosphate level in cardiovascular comorbidities like MI and CHF in Non-CKD patients.Methods: In this observational study, 300 patients were enrolled, half of the patients having Clinical features or positive biochemical markers (Troponin-I for MI and serum BNP for CHF) suggestive of myocardial infarction and heart failure were taken as case group and half of the subjects were taken as control group with similar baseline characteristics. All participants in this study were consenting and more than 18 years of age.Results: The mean value of serum phosphate level in case group was 4.41±1.40 while in control group was 3.19±1.07 showing statistically significant difference (p-value <0.001). In case group 65% patients were having MI with higher serum phosphate level (4.22±1.40).Conclusion: Higher serum phosphate level is related to increased cardiovascular morbidities even in non-CKD patients.

Antioxidant and antihyperlipidemic activity of Costus speciosus against atherogenic diet-induced hyperlipidemia in rabbits / 中西医结合学报

OBJECTIVE@#An extract of Costus speciosus (CSE), a herb widely used in folk medicine, was evaluated for its antioxidant, antihyperlipidemic and ameliorating effects on histopathological changes in atherogenic rabbits.@*METHODS@#Twenty-four male rabbits (Oryctolagus cuniculus) were divided into 4 groups. Three groups were fed a diet containing 3% saturated fat and 1.3% cholesterol for 40 d. One of these was sacrificed on the 40th day and was called the pathogenic (P) group; the other two groups received treatment for another 30 d as follows: one received 0.8 g/(kg·d) of CSE and the other was given 0.01 g/(kg·d) of simvastatin. The normal group was sacrificed on the 70th day and used as a control.@*RESULTS@#CSE showed radical-scavenging ability. Administration of CSE for a 30-day period resulted in a significant decrease in total cholesterol, triacylglycerol, low-density lipoprotein and aspartate aminotransferase compared to the P group, while levels of hemoglobin, packed corpuscular volume and red blood cells were elevated. With respect to studies performed on the heart, a decrease in malondialdehyde and an increase in reduced glutathione were noted. Total protein increased in the liver, heart and aorta after treatment with CSE and also a marked improvement in histopathological parameters was demonstrated.@*CONCLUSION@#The present findings indicate that the C. speciosus rhizome possesses antiatherogenic and antioxidant properties which may provide protective effects against oxidative stress in atherosclerotic rabbits.

Significance of emergency observation time of measurement with high-sensitive troponin T in patients with chest pain / 实用医学杂志

Objective To investigate the value of emergency observation time of chest pain patients for ruling-out myocardial infarction by using high-sensitive troponin T. Method Total 1 687 patients with chest pain from December 2015 to August 2016 visiting Sichuan University Huaxi Hospital emergency department were en-rolled.We included 1082 patients who diagnose with AMI finally.We define the time from the start of the chest pain to visiting the emergency as the onset time.We analyzed the level of high-sensitive troponin T of AMI patients at dif-ferent onset time and calculated the rate of patients with hs-cTnT level lower than the conventional hs-cTnT thresh-old of 14 ng/L. Result Among 1082 cases of AMI patients,32 patients with hs-cTnT level below threshold(14 ng/L).The for whose The onset time over 5h was observed in AMI patients with hs-cTnT level over 14 ng/L.Con-clusion AMI can not be excluded in chest pain patients whose hs-cTnT levels below the conventional threshold value of 14 ng/L,and these people should be dynamically monitored for 5h in emergency department.The patients can exclude AMI if the hs-cTnT levels are below 14 ng/L after 5 hours.

A study of clinical manifestations of right ventricular myocardial infarction

Introduction: Myocardial Infarction is the term used when the myocardium is necrosed due to ischemia. It may be trans mural or subendocardial. Inferior wall infarction has got some special features like the association with Right ventricular infarction and Brady arrhythmias especially sinus bradycardia and heart blocks. Clinically Right Ventricular Myocardial Infarction can be suspected when a patient with Inferior Wall Myocardial Infarction presents with elevated JVP, positive Kussmaul's sign, hypotension, right-sided third or fourth heart sounds, tender hepatomegaly, and oliguria rarely TR and clear chest. Aim of the study: To study the various clinical manifestation of Right Ventricular Myocardial Infarction. To study the Clinical profile, Risk factors, ECG features, Complications and Outcome of Right Ventricular Myocardial Infarction. Materials and methods: This study was mainly conducted to find out the clinical manifestations of right ventricular myocardial infarction and its risk factors, ECG features, complications and outcome of RVMI. All patients admitted to Intensive Coronary Care Unit with ST elevation in V4R were taken for study. Presence of an aneurysm, mitral regurgitation, left ventricular clot or pericardial effusion was noted. Ejection fraction was determined by-Mode and2-D using Simpson’s rule. Results: During the study period 474 cases of acute myocardial infarction were admitted and. Out of 474 cases, 242 were acute inferior wall myocardial infarction. 106 cases showed evidence of right ventricular myocardial infarction in ECG. All the 106 cases were associated with inferior wall myocardial infarction. Angina was present in 73% of patient. Angina was equivalent to 27%. All patients with chest pain were associated with sweating. Nausea, vomiting, and Indigestion were the V. Magesh, Karthikeyan K. A study of clinical manifestations of right ventricular myocardial infarction. IAIM, 2018; 5(1): 121-128. Page 122 common presenting angina equivalents in young. Dyspnea was the predominant symptom in elderly people. Most of the patients with angina equivalents were Diabetes. Conclusion: All cases of Inferior Wall Myocardial Infarction should have Right sided chest leads recorded during ECG examination as more the ST elevation more the severity of Right Ventricular Myocardial Infarction and its complications and mortality rate. If the diagnosis of Right Ventricular Myocardial Infarction is correctly made earlier and thrombolysed the prognosis is usually good even in patients with complications.

Comparison of the Effects of Qili Qiangxin Capsules and Compound Danshen Drop Pills on Related Index-es of AMI Patients without Reflow after PCI / 中国药房

OBJECTIVE:To compare the effects of Qili qiangxin capsules and Compound danshen drop pills on related indexes of acute myocardial infarction(AMI)patients without reflow after percutaneous coronary intervention(PCI). METHODS:A total of 90 AMI patients without reflow after PCI were randomly divided into Compound danshen drop pills group (45 cases) and Qili qiangxin capsules group(45 case). Both groups were given Aspirin chewable tablets 300 mg and Clopidogrel sulfate tablets 300 mg before PCI. After surgery,both groups were given Aspirin chewable tablets 100 mg,once a day+simvastatin chewable tablets 10 mg,once a day. Based on it,Compound danshen drop pills group was given Compound danshen drop pills,10 pills,3 times a day. Qili qiangxin capsules group was given Qili qiangxin capsules,4 capsules,3 times a day. Both groups were treated for consec-utive 6 months. The blood flow classification of TIMI,LEVF,β1-AR,β2-AR,α1-AR,bleeding and the occurrence of major cardio-vascular events were observed in 2 groups before and after treatment. The occurrence of ADR was recorded. RESULTS:Bafore treatment,there was no statistical significance in the blood flow classification of TIMI,the levels of β1-AR,β2-AR and α1-AR be-tween 2 groups(P>0.05). After treatment,the case number of 0-2 degree blood flow classification of TIMI in 2 groups were signif-icantly lower than before treatment while the case number of 3 degree were significantly higer than before treatment;the levels ofβ1-AR,β2-AR and α1-AR were significantly lower than before treatment,while LEVF was significantly higher than before treatment;LEVF of Qili qiangxin capsules group was significantly higher than that of Compound danshen drop pills group,with statistical signifi-cance (P0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Qili qiangxin capsules is similar to Com-pound danshen drop pills in improving no-reflow efficacy and safety of AMI patients after PCI,but it is better than Compound dan-shen drop pill in improving cardiac function.

Clinical Observation of Safflower Yellow Pigment in the Treatment of Elderly Patients with Diabetic Ne-phropathy Complicated with Acute Myocardial Infarction / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of safflower yellow pigment in the treatment of elderly pa-tients with diabetic nephropathy complicated with acute myocardial infarction. METHODS:A total of 102 elderly patients with dia-betic nephropathy complicated with acute myocardial infarction were selected from our hospital during Jan. 2013-Jun. 2015,and then divided into observation group(52 cases)and control group(50 cases)according to random number table. Control group was given routine treatment as anticoagulation,regulating blood lipid,controlling blood glucose and blood pressure. Observation group was additionally given Safflower yellow pigment for injection 150 mg added into 0.9% Sodium chloride injection 250 mL,ivgtt, qd,on the basis of control group. Both groups received treatment for 2 weeks. Clinical efficacies of 2 groups were observed. Renal function indexes(UMA,Scr,BUN,TC,TG),cardiac function indexes(EF,SV,CO,CI),inflammatory factors(CRP,IL-6, TNF-α)and hemorheological indexes(whole blood high-shear viscosity,whole blood low-shear viscosity,hematocrit,fibrinogen and platelet aggregation rate)were compared between 2 groups before and after treatment. The occurrence of ADR was recorded in 2 groups. RESULTS:Total response rate of observation group was 96.15%,which was significantly higher than 88.00% of control group,with statistical significance(P<0.05).Before treatment,there was no statistical significance in renal function indexes,cardiac function indexes,inflammatory factors or hemorheological indexes between 2 groups(P>0.05).After treatment,renal function index-es,inflammatory factors and hemorheological indexes of 2 groups were decreased significantly,while cardiac function indexes were in-creased significantly;above indicators of the observation group was significantly better than control group,with statistical significance (P<0.05).No obvious ADR was found in 2 groups.CONCLUSIONS:Safflower yellow pigment shows significant therapeutic effica-cy for elderly patients with diabetic nephropathy complicated with acute myocardial infarction,can significantly improve renal function and cardiac function,decrease inflammatory factor levels and improve hemorheological indexes with good safety.

Clinical Observation of Safflower Yellow Pigment in the Treatment of Elderly Patients with Diabetic Ne-phropathy Complicated with Acute Myocardial Infarction / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of safflower yellow pigment in the treatment of elderly pa-tients with diabetic nephropathy complicated with acute myocardial infarction. METHODS:A total of 102 elderly patients with dia-betic nephropathy complicated with acute myocardial infarction were selected from our hospital during Jan. 2013-Jun. 2015,and then divided into observation group(52 cases)and control group(50 cases)according to random number table. Control group was given routine treatment as anticoagulation,regulating blood lipid,controlling blood glucose and blood pressure. Observation group was additionally given Safflower yellow pigment for injection 150 mg added into 0.9% Sodium chloride injection 250 mL,ivgtt, qd,on the basis of control group. Both groups received treatment for 2 weeks. Clinical efficacies of 2 groups were observed. Renal function indexes(UMA,Scr,BUN,TC,TG),cardiac function indexes(EF,SV,CO,CI),inflammatory factors(CRP,IL-6, TNF-α)and hemorheological indexes(whole blood high-shear viscosity,whole blood low-shear viscosity,hematocrit,fibrinogen and platelet aggregation rate)were compared between 2 groups before and after treatment. The occurrence of ADR was recorded in 2 groups. RESULTS:Total response rate of observation group was 96.15%,which was significantly higher than 88.00% of control group,with statistical significance(P<0.05).Before treatment,there was no statistical significance in renal function indexes,cardiac function indexes,inflammatory factors or hemorheological indexes between 2 groups(P>0.05).After treatment,renal function index-es,inflammatory factors and hemorheological indexes of 2 groups were decreased significantly,while cardiac function indexes were in-creased significantly;above indicators of the observation group was significantly better than control group,with statistical significance (P<0.05).No obvious ADR was found in 2 groups.CONCLUSIONS:Safflower yellow pigment shows significant therapeutic effica-cy for elderly patients with diabetic nephropathy complicated with acute myocardial infarction,can significantly improve renal function and cardiac function,decrease inflammatory factor levels and improve hemorheological indexes with good safety.

The significance of BNP and D-dimer tests in thrombolytic therapy for patients with acute myocardial infraction / 国际检验医学杂志

Objective To investigate the significance of plasma B‐type Natriuretic Peptide(BNP) and D‐dimer test in thrombo‐lytic therapy for patients with acute myocardial infraction(AMI) .Methods Determinated the plasma levels of D‐dimer and BNP in patients diagnosed with AMI in the hospital by using full automatic immune fluorescence analyzer on admission (before treatment) , the 7th ,14the and 21th day during treatment ,respectively .Patients were divided into large ,middle and small infarction group ac‐cording to the infarct size determined by color Doppler .The correlation between BNP ,D‐dimer and infarct size were analysed .Re‐sults BNP levels in small ,medium and large infarction group were (165 .0 ± 26 .3) ,(237 .0 ± 39 .4) ,(413 .0 ± 61 .2)pg/mL ,respec‐tively ,and the differences were statistically significant(P<0 .05) .The D‐dimer plasma concentrations in the three groups were all higher than the normal reference level(P<0 .05) .In the course of thrombolytic therapy displayed a dynamic change process ,the level of D‐dimer increased first ,then maintained at a relatively high level ,and finally decreased and returned to the normal level . Conclusion The area of myocardial infarction has a certain correlation with the level of BNP ,and the dynamic monitoring of D‐di‐mer can be used to evaluate the effect of thrombolytic therapy .

Risk factors of hypotension after emergency percutaneous coronary intervention in acute myocardial infraction patient / 局解手术学杂志

Objective To explore the risk factors of hypotension of patient with acute myocardial infraction(AMI)after emergency per-cutaneous coronary intervention(PCI).Methods The data of 300 patients with AMI who received PCI in our hospital from January 2015 to August 2015 were collected.According to the symptom of hypotension,the patients were divided into hypotension group and normal group.The general information and relative clinical data were recorded and compared.The risk factors were analyzed by logistics regressive analysis. Results The incidence of previous angina of hypotension group was lower than that of normal group,the difference was significant(P 0.05).There was no difference in level of LDL-C between two groups(P >0.05).And the differences in peak value of CK-MB,inferior wall or right ventricular infarction were statistical significance (P 0.05),and the difference in others of coronary artery lesion be-tween two groups was statistical significance(P <0.05).Conclusion The peak value of CK-MB,inferior wall or right ventricular infarction and TIMI <2 after PCI can increase the possibility of hypotension after PCI,and angina pectoris before infarction can reduce the incidence of hypotension after PCI.

Effects of Titrofiban with Different Medication Timing on Blood Flow and Complications in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention / 中国药房

OBJECTIVE:To explore the effects of tirofiban with different medication timing on blood flow and complications in patients with acute myocardial infarction after percutaneous coronary intervention(PCI). METHODS:214 cases of acute ST-seg-ment elevation myocardial infarction were divided into late stage group(n=98)and early stage group(n=116)based on the order of admission. Te latter was given intravenous injection of tirofiban after PCI;the former was given intravenous injection of tirofi-ban before entered emergency room [1-2 h before PCI]. The injection-balloon dilation time was compared between 2 groups. The coronary TIMI flow situation,cardiac function and microcirculatory perfusion index before and after operation,and complications during hospitalization were also compared. RESULTS:Intravenous injection of tirofiban to balloon dilation time were 3-40 min in early stage group,and 30-65 min in late stage group,with statistical significance (t=8.94,P=0.00);during angiography,the number of patients with IRA prorsal blood flow rate to reach 2 and 3 grade was 16 cases(13.8% and 20 cases(17.2%)in early stage group,which were higher than in late stage group [7 cases (7.1%),9 cases (9.2%)],with statistical significance (P0.05). The amount of 4 and 8 h creatine kinase MB,and postoperative 24 h LVEF of 2 groups were similar after operation,without statistical significance (P>0.05);ST segment of early stage group drop value was (1.93 ± 0.57) mm,which was significantly higher than that of late stage group(1.07±0.29)mm,with statistical significance(P<0.05);the incidence of cardiac adverse events and bleeding compli-cation were 3.45%and 7.76%in early stage group,and 4.08%and 5.10%in late-stage group,without statistical significance(P<0.05). CONCLUSIONS:Different medication timing has no significant effect on the safety of tirofiban,but clinical outcomes and angiographic results are consistent. However,early treatment can improve IRA prorsal blood flow rate before PCI,which is the good medication timing of tirofiban.

Analysis of predictive factors of intestinal obstruction in acute myocardial infraction patients afterprimary percutaneous coronary intervention / 中华急诊医学杂志

Objective to determine predictive factors of intestinal obstruction in acute myocardial infraction (AMI) patients after primary percutaneous coronary intervention (PCI) and to establish predictive model.Methods A total of 1220 AMI patients underwent primary PCI in Jiangxi provincial people's hospitalfrom June2004 toJune 2014were retrospectively analyzed.And 1025 cases of them whichall met the inclusion and exclusion criteriawere randomlydivided by using random number generated by SPSS 17.0 into two cohorts:model derivation cohort (MDC) and model validation cohort (MVC).MDC was divided into intestinal obstruction group and control group.predictive factors were identified using univariable andmultivariable logistic regression analysis in MDC.Interger point values were assigned to each predictor based upon their coefficient in multivariable logistic regression model to establish scoring model.The summed scores of each case in MVC were calculated to test predictive ability of the model by ROC cure.Results Total of 1 025 patients,103 patients were diagnosed with different types of intestinal obstruction and the incidence of intestinal obstruction was 10.0％.Low position intestinal obstruction,incomplete intestinal obstruction and simple intestinal obstructionwere main characteristics in these patients.logistic regression analysis identified ten risk factorscan predict the appearance of intestinal obstruction:age ＞ 65years old (OR =1.44,95％ CI:1.26-4.63,P =0.000),diabetes mellitus (OR =3.37,95％ CI:2.39-9.47,P =0.000),habitual constipation (OR =4.75,95 ％ CI:3.58-11.24,P =0.024),inferior and extensive anterior wall myocardial infarction (OR =2.16,95％ CI:1.94-4.79,P =0.017),cardiac functiongrade≥3 class (Killip classification) (OR=2.86,95％CI:1.98-5.67,P=0.002),femoral approach (OR=2.76,95％CI:1.38-6.12,P=0.002),K+ ＜3.5 mmol/L (OR=1.86,95％CI:1.11-5.47,P =0.005),taking laxative (OR =3.59,95％ CI:2.99-10.21,P =0.000),using morphine (OR =1.98,95％ CI:1.07-3.12,P =0.021) and estimated glomerular filtration rate (eGFR) ＜60 mL · min-1 · 1.73m-2 (OR =1.19,95％ CI:1.10-3.22,P =0.031).and areas under the ROC cure was 0.815 (95％ CI:0.802-0.883,P =0.000) and indicating the accuracy of predicting intestinal obstruction.Conclusions age ＞ 65 years old,diabetes mellitus,habitual constipation,inferior and extensive anterior parts of myocardial infarction,cardiac functiongrade ≥3class (Killip classification),femoral approach,K + ＜3.5mmol/L,taking laxative,using morphine and eGFR ＜ 60 ml.min-1.1.73m2 were important predictive factors for intestinal obstruction in AMI patients after underwent 0 and the scoring model can predict accurately intestinal obstruction in such patients.

Effect of Shexiang Baoxin Pill on time difference expression of IL-18 in border zone myocardium and ventricular arrhythmia of rats with acute myocardial infarction / 中草药

Objective: To investigate the effect of Shexiang Baoxin Pill (SBP) on the inhibition of ventricular arrhythmia of rats with acute myocardial infarction. Methods: Ninety male model rats induced by left anterior descending branch ligation were randomly divided into model group, high-dose SBP treatment group, and low-dose SBP treatment group (45.0 and 22.5 mg/kg) equally (n = 30). Every group was further divided into the 1st weekend and the 2nd weekend subunits equally (n = 15). Twenty rats were taken as the Sham operation group which was further divided into the 1st weekend and the 2nd weekend subunits equally (n = 10). The rats in the high-and low-dose groups were respectively treated by ig administration of SBP for 1 or 2 weeks from day 2 after the administration, whereas the rats in the Sham operation group were not given any treatment. At the 1st weekend and the 2nd weekend, programmed electrical stimulus was imposed on the rat hearts to induce the ventricular arrhythmia. Then the left ventricle free wall tissue in the Sham operation group and the border zone myocardium in the rest of rats were preserved. The expression of myocardial IL-18 was determined. Results: Compared to the the Sham operation group, there were higher expression of myocardial IL-18 and the induced ratio of ventricular arrhythmia at 1st weekend and 2nd weekend in the model group (P < 0.01). Compared to the model group, low-dose SBP treatment could reduce the expression of myocardial IL-18 and the induced ratio of ventricular arrhythmia at 2nd weekend (P < 0.05), but there was no difference on the expression of myocardial IL-18 and the induced ratio of ventricular arrhythmia at the 1st weekend. Compared to the the model group, high-dose SBP treatment could reduce the expression of myocardial IL-18 and the induced ratio of ventricular arrhythmia at the 1st weekend and the 2nd weekend (P < 0.01). Compared to the low-dose SBP group, high-dose Shexiang Baoxin Pill treatment could reduce the expression of myocardial IL-18 and the induced ratio of ventricular arrhythmia at the 1st weekend (P < 0.01) and the 2nd weekend (P < 0.05). Conclusion: SBP may reduce the induced rate of ventricular arrhythmia of rats after acute myocardial infarction by inhibiting the over-expression of myocardial IL-18, which is in a dose dependent manner.

The clinical significance of plasma LP (a),Hcy,hs-CRP and cTnI concentrations determination in patients with acute myocardial infraction / 国际检验医学杂志

Objective To explore the clinical significance of plasma LP (a) ,Hcy ,hs-CRP and cTnI concentrations in patients with AMI .Methods Plasma LP(a) ,Hcy ,hs-CRP and cTnI concentrations of 162 patients with AMI and 165 healthy people recrui-ted as control group were determined .Immunofluorescent dry quantitative method and electro-chemiluminescence immunoassay were used in the determination ,and statistical analysis were used in data comparison .Results Before treatment ,the plasma LP(a) , Hcy ,hs-CRP and cTnI concentrations in 162 AMI patients were significantly higher than those in control group (P0 .05) ,but the plasma cTnI concentrations significantly decreased (t=3 .322 ,P<0 .01) .The plasma Hcy ,hs-CRP and cTnI concentrations in 36 died patients were significantly higher(P<0 .01) .Conclusion Plasma LP(a) ,Hcy ,hs-CRP and cTnI determination were valuable for the diagno-sis of AMI patients ,the most valuable indicators for patient prognosis and follow-up were plasma hs-CRP and cTnI .

Therapeutic effect of IABP combined noninvasive ventilator on patients with AMI complicated pump failure after emergency PCI / 心血管康复医学杂志

Objective:To explore the safety and effect of intra-aortic balloon counterpulsation (IABP) combined non-invasive ventilator on recent curative effect in patients with acute myocardial infarction (AMI) complicated pump failure after emergency percutaneous coronary intervention (PCI) .Methods:A total of 105 patients ,who hospital-ized in our CCU because of AMI complicated pump failure from Jul 2012 to Jun 2014 ,were selected .They were di-vided into IABP group (n=68 ,received IABP and noninvasive ventilator based on routine treatment ) and routine treatment group (n=37 ,received routine treatment and noninvasive ventilator therapy ) ,and all patients received e-mergency coronary angiography ,PCI and medication etc .Changes of blood pressure ,heart rate ,urine volume , echocardiography and brain natriuretic peptide (BNP) level etc .,and incidence of complications and cardiac adverse events were observed and compared between two groups during hospitalization . Results:Compared with routine treatment group during hospitalization ,blood pressure significantly rose and heart rate gradually declined to stable ;there was significant rise in left ventricular ejection fraction [(35 ± 9)% vs .(37 ± 10)% ] ,and significant reductions in BNP level [ (467 ± 197) pmol/L vs .(236 ± 146) pmol/L] ,mortality rate (28.9% vs .19.1% ) and hospital stay [ (16.2 ± 4.1) d vs .(11.6 ± 3.4) d] in IABP group , P<0.05~ <0.01 .Conclusion:IABP combined noninvasive ventilator can effectively improve patient′s condition ,stabilize hemodynamic status , reduce in-hospital mortality rate and gain time for further therapy to improve prognosis in patients with AMI complicated pump failure .

Effects of pyrrolidine dithiocarbamate on expression of NF-κB,MMP-2 and collagen remodeling after myocardial infarction in rats / 重庆医学

Objective Toinvestigatetheeffectsofpyrrolidinedithiocarbamate(PDTC)onexpressionofNF-κB,MMP-2andleft ventricular collagen remodeling following acute myocardial infarction in rats .Methods The myocardial infarction model in rat was induced by ligation of left anterior descending coronary artery .12 adult Sprague-Dawley rats survived 24 for h after acute myocardial infarction were randomly divided into the myocardial infarction (MI) group and the PDTC-treated(PD) group .Six rats were desig-nated as sham-operated group(SH group) .The PD group was intraperitoneally injected with PDTC (80 mg · kg -1 · d-1 ) for 28 d , the MI group and SH group were given normal saline as control .On 28 d ,the cardiac function of left ventricle was measured by ech-ocardiography .The infarct size was evaluated .The total collgen ,typeⅠcollgen ,typeⅢcollgen ,and Ⅰ /Ⅲ collgen ratio were quanti-fied histomorphometry .The mRNA and protein levels of NF-kappaBp65 and MMP-2 were determined by reverse transcription-poly-merase chain reaction(RT-PCR) and by Western blot ,respectively .Results Compared with the SH group ,the values of the total collgen ,typeⅠcollgen ,typeⅢcollgen ,and Ⅰ /Ⅲ collgen ratio in the MI group and the PD group were significantly increased ,the differen had statistical significance (P<0 .01) .The values of the total collgen ,typeⅠcollgen ,typeⅢcollgen ,and Ⅰ /Ⅲ collgen ratio in the PD group were notably decreased than those in the MI group(P<0 .01) .Moreover ,the mRNA and protein levels of NF-kap-paBp65 and MMP-2 in the PD group were lower than those in the MI group ,the difference had statistical significance(P<0 .01) . Conclusion Left ventricular collagen remodeling following acute myocardial infarction could be improved by PDTC to some extent , which mechanism could be related with inhibiting NF-kappaB activation and down -regulating the expression of MMP-2 in rats .

Effect of Blood Glucose Levels on Lipid-lowering Therapy in Patients with Myocardial Infraction / 中国康复理论与实践

@#Objective To investigate the effect of blood glucose levels on lipid-lowering therapy in patients with myocardial infraction (MI).Methods The data of 174 patients with acute or old MI and finished a two-year follow-up were analyzed retrospectively. The patients were divided into four groups: diabetes mellitus (DM) with well blood glucose control (DM+W group), diabetes mellitus with bad blood glucose control (DM+B group), non-diabetes mellitus with well blood glucose control (NDM+W group) and non-diabetes mellitus with bad blood glucose control (NDM+B group). Blood lipids levels, dose and side effects of statins were statistically analyzed.Results All the 174 patients had a mean follow-up period of 28±7 months, and 51 patients (25.9%) had diabetes mellitus. In DM+B group (n=13, 25.5%) and NDM+B group (n=24, 19.5%), there were no statistically difference between enrollment and 2-year follow-up in the mean levels of blood total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-c) and low density lipoprotein cholesterol (LDL-c), but the mean level of LDL-c had a trend of elevation. In DM+W group, the mean level of LDL-c was 2.57 mmol/L at 2-year follow-up, which did not achieve the recommended LDL-c goal (2.06 mmol/L). There were no differences in statin therapy between each group. After 2-year follow-up, there were only 93 patients (53.4%) received normal dose of statin, 60 patients (34.5%) took low dose of statin and 16 patients (9.2%) had no statin therapy. There were no differences in hepatic enzyme abnormality between each group.Conclusion The bad control of blood glucose in patients with MI effect the efficacy of statins in lipid-lowering therapy. The doses of statin are insufficient especial in patients with MI and DM.