ABSTRACT
Objective@#To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI).@*Methods@#Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization.@*Results@#There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all P>0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, P<0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, P=0.004). Multivariate logistic regression analysis showed that FAR (OR=0.492, 95%CI 0.354-0.686, P<0.001), serum uric acid (OR=0.994, 95%CI 0.989-0.999, P=0.018) and high-sensitivity C-reactive protein (OR=0.774, 95%CI 0.614-0.975, P=0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95%CI 0.630-0.758, P<0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%.@*Conclusion@#The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.
ABSTRACT
Spontaneous recanalization after chronic occlusion of internal carotid artery (ICA) is a rare phenomenon, and its mechanism is not clear. This article reports a case of chronic occlusion of the extracranial segment of the right ICA. The right ICA occlusion was confirmed by the DSA and one year later, DSA showed the recanalization of occlusion ICA with tandem stenosis of the origin and the proximal petrosal segment. Carotid artery stenting was successfully performed, and postoperative angiography showed that the right ICA was patent and the stenosis was obviously improved. Therefore, drug therapy could be continued when artery lumen was completely normal or slightly narrow after spontaneous recanalization of chronic internal carotid artery occlusion;carotid endarterectomy or carotid artery stenting may be considered for tandem stenosis or severe stenosis with high risk of ischemic events.
ABSTRACT
Objective To investigate the correlation between procalcitonin (PCT) and infarct related artery (IRA) spontaneous recanalization (SR) in patients with ST-segment elevation myocardial infarction (STEMI), and to investigate the value of PCT in predicting SR. Methods A retrospective study was conducted. A total of 263 STEMI patients who received emergency coronary angiography from January 2013 to April 2016 in cardiology department of Gansu Provincial Hospital were retrospectively included. Depending on the thrombolysis in myocardial infarction trial (TIMI) grade, the patients were divided into two groups, SR group (TIMI 2-3 grade) and non-SR group (NSR group, TIMI 0-1 grade). The baseline characteristics, serum PCT, high sensitivity C-reactive protein (hs-CRP) and biochemical makers before primary percutaneous coronary intervention (PCI) were compared. According to the value of PCT, the patients were divided into four quartile groups. SR rate of every groups were compared. Multiple logistic regression analysis was used to determine the independent predictor of SR. Receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of PCT for SR. Results In 263 STEMI patients, SR occurred in 77 patients and SR rate was 29.3%. There were no statistical differences in gender, age, body mass index (BMI), past medical history and IRA between the two groups, indicating that the baseline characteristics were matched. Compared with NSR group, utilization rate of the statins were significantly higher (35.1% vs. 22.6%, P 0.110 μg/L. SR rate were 48.5% (32/66), 29.9% (20/67), 26.9% (18/67) and 11.1% (7/63), respectively. SR rate of Quartile 1 was significantly higher than the other three groups (all P < 0.05). It was shown by multiple logistic regression analysis that PCT [odds ratio (OR) = 0.432, 95% confidence interval (95%CI) = 0.108-0.863, P = 0.016], hs-CRP (OR = 0.708, 95%CI = 0.516-0.905, P = 0.037) were independent predictors for SR. The area under the ROC curve (AUC) of PCT for predicting SR was greater than that of hs-CRP [0.784 (95%CI = 0.721-0.847) vs. 0.686 (95%CI = 0.619-0.753), P < 0.05]. When the cut-off value of PCT was 0.067 μg/L, the sensitivity was 81.6%, and the specificity was 66.7%. Conclusion PCT was independent predictor of SR, which has a power value in predicting IRA recanalization in patients with STEMI.