O Valor Preditivo do Índice Prognóstico Inflamatório para Detecção de No-Reflow em Pacientes com Infarto do Miocárdio com Supradesnivelamento do Segmento ST / The Predictive Value of the Inflammatory Prognostic Index for Detecting No-Reflow in ST-Elevation Myocardial Infarction Patients

Resumo Fundamento: O no-reflow (NR) é caracterizado por uma redução aguda no fluxo coronário que não é acompanhada por espasmo coronário, trombose ou dissecção. O índice prognóstico inflamatório (IPI) é um novo marcador que foi relatado como tendo um papel prognóstico em pacientes com câncer e é calculado pela razão neutrófilos/linfócitos (NLR) multiplicada pela razão proteína C reativa/albumina. Objetivo: Nosso objetivo foi investigar a relação entre IPI e NR em pacientes com infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) submetidos a intervenção coronária percutânea primária (ICPp). Métodos: Um total de 1.541 pacientes foram incluídos neste estudo (178 com NR e 1.363 com refluxo). A regressão penalizada LASSO (Least Absolute Shrinkage and Select Operator) foi usada para seleção de variáveis. Foi criado um nomograma baseado no IPI para detecção do risco de desenvolvimento de NR. A validação interna com reamostragem Bootstrap foi utilizada para reprodutibilidade do modelo. Um valor de p bilateral <0,05 foi aceito como nível de significância para análises estatísticas. Resultados: O IPI foi maior em pacientes com NR do que em pacientes com refluxo. O IPI esteve associado de forma não linear com a NR. O IPI apresentou maior capacidade discriminativa do que o índice de imunoinflamação sistêmica, NLR e relação PCR/albumina. A adição do IPI ao modelo de regressão logística multivariável de base melhorou a discriminação e o efeito do benefício clínico líquido do modelo para detecção de pacientes com NR, e o IPI foi a variável mais proeminente no modelo completo. Foi criado um nomograma baseado no IPI para prever o risco de NR. A validação interna do nomograma Bootstrap mostrou uma boa capacidade de calibração e discriminação. Conclusão: Este é o primeiro estudo que mostra a associação de IPI com NR em pacientes com IAMCSST submetidos a ICPp.

Abstract Background: No-reflow (NR) is characterized by an acute reduction in coronary flow that is not accompanied by coronary spasm, thrombosis, or dissection. Inflammatory prognostic index (IPI) is a novel marker that was reported to have a prognostic role in cancer patients and is calculated by neutrophil/lymphocyte ratio (NLR) multiplied by C-reactive protein/albumin ratio. Objective: We aimed to investigate the relationship between IPI and NR in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI). Methods: A total of 1541 patients were enrolled in this study (178 with NR and 1363 with reflow). Lasso panelized shrinkage was used for variable selection. A nomogram was created based on IPI for detecting the risk of NR development. Internal validation with Bootstrap resampling was used for model reproducibility. A two-sided p-value <0.05 was accepted as a significance level for statistical analyses. Results: IPI was higher in patients with NR than in patients with reflow. IPI was non-linearly associated with NR. IPI had a higher discriminative ability than the systemic immune-inflammation index, NLR, and CRP/albumin ratio. Adding IPI to the baseline multivariable logistic regression model improved the discrimination and net-clinical benefit effect of the model for detecting NR patients, and IPI was the most prominent variable in the full model. A nomogram was created based on IPI to predict the risk of NR. Bootstrap internal validation of nomogram showed a good calibration and discrimination ability. Conclusion: This is the first study that shows the association of IPI with NR in STEMI patients who undergo pPCI.

Além do Escore GRACE SCA: É Necessário um Modelo Diferente para Homens e Mulheres após IAMCSST? / Beyond the GRACE ACS Score: Do We Need a Different Model for Men and Women after STEMI?

Resumo Fundamento As mulheres, em comparação aos homens, apresentam piores resultados após a síndrome coronariana aguda (SCA). No entanto, ainda não está claro se o sexo feminino em si é um preditor independente de tais eventos adversos. Objetivo Este estudo tem como objetivo avaliar a associação entre o sexo feminino e a mortalidade hospitalar após infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST). Métodos Conduzimos um estudo de coorte retrospectivo, recrutando pacientes consecutivos com IAMCSST, internados em um hospital terciário de janeiro de 2018 a fevereiro de 2019. Todos os pacientes foram tratados de acordo com as recomendações das diretrizes atuais. Modelos de regressão logística multivariada foram aplicados para avaliar a mortalidade hospitalar utilizando variáveis de GRACE. A precisão do modelo foi avaliada usando o índice c. Um valor de p < 0,05 foi estatisticamente significativo. Resultados Dos 1.678 pacientes com SCA, 709 apresentaram IAMCSST. A população era composta por 36% de mulheres e a idade média era de 61 anos. As mulheres tinham maior idade (63,13 anos vs. 60,53 anos, p = 0,011); apresentavam hipertensão (75,1% vs. 62,4%, p = 0,001), diabetes (42,2% vs. 27,8%, p < 0,001) e hiperlipidemia (34,1% vs. 23,9%, p = 0,004) mais frequentemente; e apresentaram menor probabilidade de serem submetidas a intervenção coronária percutânea (ICP) por acesso radial (23,7% vs. 46,1%, p < 0,001). A taxa de mortalidade hospitalar foi significativamente maior em mulheres (13,2% vs. 5,6%, p = 0,001), e o sexo feminino permaneceu em maior risco de mortalidade hospitalar (OR 2,79, IC de 95% 1,15-6,76, p = 0,023). Um modelo multivariado incluindo idade, sexo, pressão arterial sistólica, parada cardíaca e classe de Killip atingiu 94,1% de precisão na previsão de mortalidade hospitalar, e o índice c foi de 0,85 (IC de 95% 0,77-0,93). Conclusão Após ajuste para os fatores de risco no modelo de previsão do GRACE, as mulheres continuam em maior risco de mortalidade hospitalar.

Abstract Background Women, in comparison to men, experience worse outcomes after acute coronary syndrome (ACS). However, whether the female sex per se is an independent predictor of such adverse events remains unclear. Objective This study aims to assess the association between the female sex and in-hospital mortality after ST-elevation myocardial infarction (STEMI). Methods We conducted a retrospective cohort study by enrolling consecutive STEMI patients admitted to a tertiary hospital from January 2018 to February 2019. All patients were treated per current guideline recommendations. Multivariable logistic regression models were applied to evaluate in-hospital mortality using GRACE variables. Model accuracy was evaluated using c-index. A p-value < 0.05 was statistically significant. Results Out of the 1678 ACS patients, 709 presented with STEMI. The population consisted of 36% women, and the median age was 61 years. Women were older (63.13 years vs. 60.53 years, p = 0.011); more often presented with hypertension (75.1% vs. 62.4%, p = 0.001), diabetes (42.2% vs. 27.8%, p < 0.001), and hyperlipidemia (34.1% vs. 23.9%, p = 0.004); and were less likely to undergo percutaneous coronary intervention (PCI) via radial access (23.7% vs. 46.1%, p < 0.001). In-hospital mortality rate was significantly higher in women (13.2% vs. 5.6%, p = 0.001), and the female sex remained at higher risk for in-hospital mortality (OR 2.79, 95% CI 1.15-6.76, p = 0.023). A multivariate model including age, sex, systolic blood pressure, cardiac arrest, and Killip class was 94.1% accurate in predicting in-hospital mortality, and the c-index was 0.85 (95% CI 0.77-0.93). Conclusion After adjusting for the risk factors in the GRACE prediction model, women remain at higher risk for in-hospital mortality.

Implicancias de la inteligencia artificial en los métodos de imagen endovascular / Implications of Artificial Intelligence in Intravascular Imaging Methods

RESUMEN La angioplastia transluminal coronaria (ATC) es una de las principales estrategias de revascularización en pacientes con enfermedad coronaria aterosclerótica (ECA). Numerosos estudios respaldan la optimización de la ATC mediante métodos de imagen endovascular; sin embargo, estos métodos son subutilizados en la práctica clínica contemporánea y enfrentan desafíos en la interpretación de los datos obtenidos, por lo que la integración de la inteligencia artificial (IA) se vislumbra como una solución atractiva para promover y simplificar su uso. La IA se define como un programa computarizado que imita la capacidad del cerebro humano para recopilar y procesar datos. El aprendizaje de máquinas es una subdisciplina de la IA que implica la creación de algoritmos capaces de analizar grandes conjuntos de datos sin suposiciones previas, mientras que el aprendizaje profundo se centra en la construcción y entrenamiento de redes neuronales artificiales profundas y complejas. Así, se ha demostrado que la incorporación de sistemas de IA a los métodos de imagen endovascular incrementa la precisión de la ATC, disminuye el tiempo del procedimiento y la variabilidad interobservador en la interpretación de los datos obtenidos, promueve así una mayor adopción y facilita su utilización. El propósito de la presente revisión es destacar cómo los sistemas actuales basados en IA pueden desempeñar un papel fundamental en la interpretación de los datos generados por los métodos de imagen endovascular, lo que conduce a una mejora en la optimización de la ATC en pacientes con ECA.

ABSTRACT Percutaneous coronary intervention (PCI) is one of the primary revascularization strategies in patients with coronary artery disease (CAD). Several studies support the use of intravascular imaging methods to optimize PCI. However, these methods are underutilized in contemporary clinical practice and face challenges in data interpretation. Therefore, the incorporation of artificial intelligence (AI) is seen as an attractive solution to promote and simplify their use. AI can be defined as a computer program that mimics the human brain in its ability to collect and process data. Machine learning is a sub-discipline of AI that involves the creation of algorithms capable of analyzing large datasets without making prior assumptions, while deep learning focuses on the construction and training of deep and complex artificial neural networks. The incorporation of AI systems to intravascular imaging methods improves the accuracy of PCI, reduces procedure duration, and minimizes interobserver variability in data interpretation. This promotes their wider adoption and facilitates their use. The aim of this review is to highlight how current AI-based systems can play a key role in the interpretation of data generated by intravascular imaging methods and optimize PCI in patients with CAD.

Influencia del antecedente de intervención coronaria percutánea sobre los desenlaces angiográficos y clínicos en pacientes con infarto agudo de miocardio con elevación del segmento ST / Impact of previous percutaneous coronary intervention on angiographic and clinical outcomes in patients with ST-segment elevation myocardial infarction

Resumen Antecedentes: El pronóstico de los pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST) y antecedente de intervención coronaria percutánea (ICP) es incierto. Objetivos: Evaluar si la ICP previa en pacientes con IAMCEST incrementa el riesgo de eventos cardiovasculares mayores y si el flujo final epicárdico varía según la estrategia de reperfusión. Material y métodos: Subestudio de PHASE-MX, observacional, longitudinal y comparativo, de pacientes con IAMCEST reperfundidos en menos de 12 horas de iniciados los síntomas, divididos conforme el antecedente de ICP. El acaecimiento del criterio de valoración principal (muerte cardiovascular, reinfarto, insuficiencia cardíaca y choque cardiogénico) dentro de los 30 días se comparó con estimaciones de Kaplan-Meier, prueba de rangos logarítmicos y modelo de riesgos proporcionales de Cox. El flujo epicárdico final se evaluó con el sistema de clasificación del flujo TIMI después de la reperfusión. Resultados: Se incluyeron 935 pacientes, 85.6 % del sexo masculino, 6.9 % de los cuales tenía antecedente de ICP; 53 % recibió terapia farmacoinvasiva y 47 %, ICP primaria. La incidencia del criterio de valoración principal en pacientes con ICP previa fue de 9.8 % versus 13.3 % en aquellos sin ese antecedente (p = 0.06); 87.1 % de los pacientes con ICP previa obtuvo flujo final de grado TIMI 3 versus 75 % del grupo con estrategia farmacoinvasiva (p = 0.235). Conclusiones: El antecedente de ICP no incrementa el riesgo de eventos cardiovasculares mayores a los 30 días en pacientes con IAMCEST; sin embargo, impacta negativamente en el flujo sanguíneo angiográfico final de los pacientes que recibieron terapia farmacoinvasiva (en comparación con ICP primaria).

Abstract Background: The prognosis of patients with ST-segment elevation myocardial infarction (STEMI) and previous percutaneous coronary intervention (PCI) is uncertain. Objectives: To evaluate if previous PCI in patients with STEMI increases the risk of major cardiovascular events, and if final epicardial blood flow differs according to the reperfusion strategy. Material and methods: Observational, longitudinal, comparative sub-study of the PHASE-MX trial that included patients with STEMI and reperfusion within 12 hours of symptom onset, who were divided according to their history of PCI. The occurrence of the composite primary endpoint (cardiovascular death, re-infarction, congestive heart failure and cardiogenic shock) within 30 days was evaluated using Kaplan-Meier estimates, log-rank test and Cox proportional hazards model. Final epicardial blood flow was assessed using the TIMI grading system after reperfusion. Results: A total of 935 patients were included; 85.6% were males, and 6.9% had a history of PCI; 53% underwent pharmacoinvasive therapy, and 47%, primary PCI. The incidence of the composite primary endpoint at 30 days in patients with a history of PCI was 9.8% vs. 13.3% in those with no previous PCI (p = 0.06). Among the patients with previous PCI, 87.1% reached a final TIMI grade 3 flow after primary PCI vs. 75% in the group with pharmacoinvasive strategy (p = 0.235). Conclusions: A history of PCI does not increase the risk of major cardiovascular events at 30 days; however, it impacted negatively on the final angiographic blood flow of patients that received pharmacoinvasive therapy (compared to primary PCI).

Comparative Study on Effect of Yiqi Liangxue Shengji Formula （益气凉血生肌方） and Atorvastatin Tablets on Vascular Injury and Differences in Serum Metabolites in Abdominal Aortic Balloon Injury Model Rats / 中医杂志

ObjectiveTo compare the effects and differences of Yiqi Liangxue Shengji Formula （益气凉血生肌方） and atorvastatin on the repair of vascular injury in rats from the perspective of metabolomics. MethodsTwenty-four male SD rats were randomly divided into sham-surgery， model， traditional Chinese medicine （TCM）， and ator-vastatin groups， with 6 rats in each group. The rat model was established by balloon-induced abdominal aorta injury. Gavage was started on the day after surgery in all groups of rats. The sham and model groups were given with deio-nized water， TCM group received Yiqi Liangxue Shengji Formula 6 g/（kg·d）， and the atorvastatin group treated with atorvastatin suspension 2 mg/（kg·d） for 4 weeks. HE staining was used to observe the pathological morphology of the injured segment of the abdominal aorta； ELISA detection was used to test serum nitric oxide （NO） and C-reactive protein （CRP） levels； UPLC MS/MS technology was used for widely targeted metabolomics detection in serum， and multivariate statistical analysis was used to screen metabolic markers and pathways of two drugs； finally， compare serum levels of key metabolic markers of the above two medications in rats of each group. ResultsCompared with the sham-surgery group， the neointima significantly thickened， the level of NO decreased significantly and the level of CRP increased in serum of the model group （P＜0.01）； compared with the model group， the degree of arterial intimal hyperplasia in TCM group and atorvastatin group reduced， with an increase in NO levels and a decrease in CRP levels （P＜ 0.05 or P＜0.01）. The results of serum metabolomics showed that TCM group obtained 49 metabolic markers and 6 metabolic pathways， while atorvastatin group obtained 41 metabolic markers and 4 metabolic pathways. The two medications jointly regulated 38 metabolites. Glycerophospholipid metabolism and arginine-related metabolism were common metabolic pathways for both medications. Lysophosphatidylcholine （16∶1/0∶0） ［LPC （16∶1/ 0∶0）］， phosphatidylcholine （15∶0/15∶0） ［PC （15∶0/15∶0）］ were the key metabolites of glycerophospholipid metabolic pathway； ornithine， spermidine were the key metabolites of arginine-related metabolic pathway. The tricarboxylic acid cycle and glutathione metabolism were the unique metabolic pathways of Yiqi Liangxue Shengji Formula. Compared with the sham-surgery group， LPC （16∶1/0∶0）， ornithine， and spermidine levels elevated and PC （15∶0/15∶0） levels decreased in the model group （P＜0.05 or P＜0.01）. Compared with the model group， LPC （16∶1/0∶0）， ornithine， and spermidine levels decreased， and PC （15∶0/15∶0） levels increased in both TCM group and atorvastatin group （P＜0.05 or P＜0.01）. The degree of LPC reduction （16∶1/0∶0） was more significant in atorvastatin group compared with that in the TCM group （P＜0.01）. ConclusionsBoth sham-surgery and atorvastatin could regulate lipid metabolism and arginine-related metabolism， exert the characteristics of lipid-lowering， anti-inflammatory， improve arginine/NO bioavailability， and improve endothelial dysfunction. Atorvastatin showed more advantages in lipid-lowering and anti-inflammatory， while Yiqi Liangxue Shengji Formula has unique characteristics in regulating energy metabolism and improving oxidative stress.

Evaluating the role of quantitative flow ratio in percutaneous coronary intervention using regadenoson stress D-SPECT / 西安交通大学学报(医学版)

【Objective】 To evaluate the role of quantitative flow ratio (QFR) in percutaneous coronary intervention (PCI) by using regadenoson stress dynamic single-photon emission computed tomography (D-SPECT). 【Methods】 We selected 200 patients with unstable angina admitted to Department of Cardiology, Hebei Medical University First Hospital, from June 31, 2021 to June 31, 2023 for elective PCI. The patients were aged 57.56±8.23 years and were randomly divided into a conventional group (n=100) and a QFR group (n=100) according to a random number table. The trial was conducted using a double-blind method. The conventional group received PCI treatment based on the experience of the physician, while the QFR group received PCI treatment based on the QFR measurement results. All enrolled patients underwent pre-operative and 7-day post-operative D-SPECT stress imaging using regadenoson stress D-SPECT, and their images were acquired from short axis, vertical long axis, and horizontal long axis to calculate the total myocardial perfusion score and the total myocardial ischemia segment number under the distribution of 17 myocardial segments. 【Results】 There was no significant difference in the number of myocardial ischemia segments (7.59±3.14 vs. 7.48±3.36, P=0.811) or the total myocardial perfusion score (15.87±7.61 vs. 15.63±5.97, P=0.860) between the two groups before PCI. The number of myocardial ischemia segments (5.58±3.36 vs. 6.51±2.14, P=0.020) and the total myocardial perfusion score (10.55±4.41 vs. 12.96±6.50, P=0.002) in the QFR group were significantly better than those in the conventional group 7 days after PCI (P<0.05). 【Conclusion】 Applying QFR guidance for PCI can better improve the degree of myocardial ischemia in patients.

Effect of applying recombinant human prourokinase during emergency percutaneous coronary intervention on the prognosis of patients with acute ST segment elevation myocardial infarction / 中国医师进修杂志

Objective:To investigate the effect of different administration methods of recombinant human prourokinase (rhPro-UK) during emergency percutaneous coronary intervention (PCI) on myocardial perfusion and prognosis of patients with acute ST segment elevation myocardial infarction (STEMI).Methods:The clinical data of 132 patients with STEMI who underwent emergency PCI in the Military Hospital of the 71st Army Group of the Chinese People′s Liberation Army from August 2017 to August 2022 were analyzed retrospectively. Among them, 66 patients treated with rhPro-UK injection after the guide wire passed through the coronary artery lesion, balloon dilation and stent placement were included in group A. The other 66 patients treated with rhPro-UK injection once after the guide wire passed through the coronary artery lesion were included in group B. The two groups were compared in terms of PCI conditions, target vessel perfusion status [corrected TIMI frame count (CTFC) and blood flow (thrombolysis in myocardial infarction, TIMI) grade], myocardial perfusion status [TIMI myocardial perfusion grade (TMPG), ST segment regression rate (STR) at 90 min after operation and the incidence of no reflow/slow flow (NR/SF)], cardiac function indicators [left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV) and left ventricular ejection fraction (LVEF)], the incidence of major adverse cardiovascular events (MACE), and the incidence of bleeding events.Results:There were no statistically significant differences between the two groups in terms of the distribution of culprit blood vessels, intubation methods, and number of stents implanted ( P>0.05). After treatment, the proportion of TIMI blood flow grade 3 in the group A was higher than that in the group B:99.97% (64/66) vs. 87.88% (58/66). CTFC of the two tgroups decreased, and CTFC of group A was lower than that of group B: (23.49 ± 4.27) frames vs. (27.14 ± 4.83) frames ( P<0.05). The proportion of TMPG grade 3 in group A was significantly higher than that in group B: 95.45% (63/66) vs. 83.33% (55/66)( P<0.05). STR in group A was significantly higher than that in group B: 95.45% (63/66) vs. 83.33% (55/66)( P<0.05). The incidence of NR/SF in group A was lower than that in group B: 3.03% (2/66) vs. 14.29% (10/66)( P<0.05). There were no statistically significant differences in LVEDV or LVESV between the two groups before and after treatment ( P>0.05). After 1 month of treatment, LVEF of the two groups increased, and LVEF of group A was higher than that of group B: (71.08 ± 6.38) % vs. (66.24 ± 6.49) % ( P<0.05). After treatment, the incidence of MACE in group A was lower than that in group B: 6.06%(4/66) vs. 13.64%(9/66) ( χ2 = 2.13, P = 0.144). There was no statistically significant difference in the incidence of bleeding events between the two groups ( P>0.05). Conclusions:For patients with STEMI undergoing PCI, fractional injection of rhPro-UK can better improve myocardial perfusion, reduce the incidence of MACE, and effectively improve the prognosis, compared with one-time injection of rhPro-UK.

Correlation of neutrophil/lymphocyte ratio with cardiac function and prognosis in patients with acute myocardial infarction after percutaneous coronary intervention / 中国基层医药

Objective:To correlate neutrophil/lymphocyte ratio (NLR) with cardiac function in patients with acute myocardial infarction (ACI) after percutaneous coronary intervention (PCI) and investigate its clinical value in predicting major adverse cardiovascular events (MACEs) in patients.Methods:A total of 120 patients with AMI who underwent PCI at Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine from March 2020 to February 2023 were included in this prospective study. The difference in NLR measured 1 day after PCI relative to that measured at 5 days after surgery (?NLR) was correlated with cardiac function ultrasound indicators measured at 3 months after surgery, myocardial injury, and inflammatory biochemical indicators at 1 day after surgery. The MACEs occurring within 3 months after surgery were recorded. The value of ΔNLR recorded during the early stage after PCI for predicting MACEs in patients with AMI was evaluated.Results:At 3 months after surgery, 13 out of 120 patients with AMI (10.83%) had MACEs. The ?NLR in patients with AMI who had MACEs was (3.55 ± 0.47), which was significantly higher than (2.06 ± 0.34) in patients with AMI who had no MACEs ( t = 17.25, P < 0.001). An optimal critical value of ?NLR for predicting MACEs after PCI in patients with AMI was 2.75, with an area under the receiver operating characteristic curve of 0.972, a sensitivity of 90.70%, and a specificity of 91.10%. Conclusion:Increased NLR during the early stage after PCI in patients with AMI is closely related to decreased cardiac function, and worsened myocardial injury and inflammatory reactions. Changes in NLR after PCI in patients with AMI have a highly valuable value for predicting MACEs in these patients.

Analysis of related factors of restlessness during the anesthesia recovery period in children with patent ductus arteriosus after interventional surgery / 中国基层医药

Objective:To investigate the related factors of restlessness during the anesthesia recovery period in children with patent ductus arteriosus after interventional surgery.Methods:The clinical data of 92 pediatric patients with patent ductus arteriosus who underwent cardiac catheterization at Children's Hospital, Zhejiang University School of Medicine from November 2019 to October 2020 were retrospectively analyzed. These patients were divided into two groups based on the occurrence of restlessness during the anesthesia recovery period: a control group ( n = 67, without restlessness) and an observation group ( n = 25, with restlessness). Clinical data from both groups were collected and compared. Univariate and multivariate analyses were conducted to identify independent risk factors for restlessness during the anesthesia recovery period among pediatric patients with patent ductus arteriosus after interventional surgery. Results:Univariate analysis revealed no statistically significant differences in gender, age, temperament type, surgical duration, resuscitation room stay time, as well as blood pressure, heart rate, and blood oxygen saturation during the anesthesia recovery period between the two groups (all P > 0.05). However, the use of dexmedetomidine during surgery, preoperative anxiety, postoperative pain, and the use of antagonists were identified as risk factors for postoperative restlessness among pediatric patients with patent ductus arteriosus after interventional surgery χ2 = 9.03, 4.95, 5.84, 11.49, all P < 0.05). Multivariate regression analysis results further revealed that preoperative anxiety, postoperative pain, and the use of antagonists were independent risk factors for postoperative restlessness ( OR = 2.870, 4.083, 6.975, P = 0.029, 0.004, 0.002, 95% CI = 1.114-7.389, 1.555-10.722, 2.052-23.711), while intraoperative use of dexmedetomidine served as a protective factor ( OR = 0.318, P = 0.021, 95% CI = 0.120-0.839, all P < 0.05). Conclusion:The intraoperative use of dexmedetomidine, preoperative anxiety, postoperative pain, and the use of antagonists are identified as independent risk factors for postoperative restlessness in pediatric patients with patent ductus arteriosus after interventional surgery. It is crucial for clinicians to be aware of these factors and take preventive measures during the anesthesia recovery period to minimize the potential for harm resulting from postoperative restlessness.

Review of clinical research on antiplatelet therapy in percutaneous coronary intervention in 2023 / 中国介入心脏病学杂志

@#How to optimize antiplatelet therapy in percutaneous coronary intervention is always a daily problem in clinical practice.In 2023,the research mainly focused on evaluating the efficacy and safety of single-drug therapy strategy of P2Y12 receptor antagonist without aspirin and de-escalation of antiplatelet therapy,which provided more evidence-based evidence for clinical these strategies.The future direction will include applicatian of new therapeutic targets,developing new antiplatelet drugs,using existing drugs to implement more innovative antithrombotic therapy schemes and further research to verify the more widely used contemporary antiplatelet strategies.

The predictive value of t-PA,CgA,LP-PLA2 for MACE after percutaneous coronary intervention / 国际检验医学杂志

Objective To investigate the predictive value of tissue plasminogen activator(t-PA),chro-mogranin A(CgA),and lipoprotein related phospholipase A2(LP-PLA2)in serum for major adverse cardio-vascular event(MACE)after percutaneous coronary intervention(PCI).Methods A total of 120 patients with coronary heart disease who underwent PCI in the hospital from August 2020 to August 2022 were en-rolled in the study.According to whether MACE occurred within 1 year after PCI,the patients were divided into MACE group(33 cases)and non-MACE group(87 cases).The levels of serum t-PA,CgA,LP-PLA2 and clinical data were compared between the MACE group and the non-MACE group.Multivariate Logistic regres-sion was used to analyze the risk factors of MACE after PCI.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of t-PA,CgA and LP-PLA2 alone or in combination for MACE after PCI.Results The proportion of patients with smoking history,NT-proBNP,CgA,LP-PLA2,and the propor-tion of patients with hypertension in the MACE group were higher than those in the non-MACE group(P＜0.05),while left ventricular ejection fraction(LVEF)and t-PA were lower than those in the non-MACE group(P＜0.05).There were no significant differences in age,gender composition,serum creatinine,triglyc-erides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),drinking history,NYHA cardiac function classification,combined diabetes,application of aspirin,and application of clopidogrel between the two groups(P＞0.05).Multivariate Logistic regression analysis showed that smoking history,increased NT-proBNP,hypertension,decreased LVEF,decreased t-PA,increased CgA and increased LP-PLA2 were risk factors for MACE after PCI(P＜0.05).ROC curve analysis showed that the areas under the curves(AUCs)of serum t-PA,CgA and LP-PLA2 alone or in combination for predicting MACE after PCI were 0.785(95％CI:0.693-0.877),0.678(95％CI:0.564-0.791),0.730(95％CI:0.636-0.824),0.888(95％CI:0.830-0.946),respectively.The efficacy of combined prediction was bet-ter than those of single detections(P＜0.05).Conclusion The lower the serum t-PA level is and the higher the CgA and LP-PLA2 levels are,the greater the risk of MACE after PCI is.The combination of the three in-dicators has higher value in predicting MACE after PCI.

Influence of Qishen Yiqi Guttate Pills on the Clinical Efficacy of Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention / 广州中医药大学学报

Objective To observe the influence of Qishen Yiqi Guttate Pills(mainly composed of Astragali Radix,Salviae Miltiorrhizae Radix et Rhizoma,Notoginseng Radix et Rhizoma,and Dalbergiae Odoriferae Lignum)on the clinical efficacy of patients with acute myocardial infarction after percutaneous coronary intervention(PCI).Methods Sixty post-PCI patients with acute myocardial infarction of qi deficiency and blood stasis type who met the inclusion criteria were randomly divided into a treatment group and a control group,with 30 patients in each group.The control group was treated with conventional western medicine,and the treatment group was treated with Qishen Yiqi Guttate Pills on the basis of treatment for the control group.The course of treatment for the two groups lasted for 3 months.The changes of cardiac function indicators and serum levels of hypersensitive C-reactive protein(hs-CRP)and N-terminal B-type natriuretic peptide precursor(NT-pro BNP)were observed before and after the treatment in the two groups,and the incidence of cardiovascular adverse events during the treatment in the two groups were also compared.Results(1)After treatment,the serum hs-CRP and NT-pro BNP levels of patients in the two groups were significantly decreased(P＜0.05)and the left ventricular ejection fraction(LVEF)was significantly increased(P＜0.05)compared with those before treatment.And the effects on lowering the levels of serum hs-CRP and NT-pro BNP and on increasing LVEF of the treatment group were significantly superior to those of the control group,the differences being statistically significant(P＜0.05).(2)During the treatment period,the incidence of cardiovascular adverse events in the treatment group was 6.67%(2/30),which was significantly lower than 26.67%(8/30)of the control group,and the difference was statistically significant when comparing the two groups(P＜0.05).Conclusion Qishen Yiqi Guttate Pills can effectively improve cardiac function,decrease serum hs-CRP and NT-pro BNP levels,and reduce the occurrence of adverse cardiovascular events in post-PCI patients with acute myocardial infarction of qi deficiency and blood stasis type.

Efficacy and safety of nicorandil and ticagrelor de-escalation after percutaneous coronary intervention for elderly patients with acute coronary syndrome / 解放军医学杂志

Objective To explore the efficacy and safety of ticagrelor de-escalation and nicorandil therapy in elderly patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 300 elderly patients with ACS were selected from the Sixth and Seventh Medical Center of Chinese PLA General Hospital and Beijing Chaoyang Integrative Medicine Emergency Rescue and First Aid Hospital from November 2016 to June 2019,including 153 males and 147 females,aged>65 years old.All the patients received PCI,and all had double antiplatelet therapy(DAPT)scores≥2 and a new DAPT(PRECISE-DAPT)score of≥25.All patients were divided into two groups by random number table method before operation:ticagrelor group(n=146,ticagrelor 180 mg load dose followed by PCI,and ticagrelor 90 mg bid after surgery)and ticagrelor de-escalation + nicorandil group(n=154,ticagrelor 180 mg load dose followed by PCI,ticagrelor 90 mg bid+nicorandil 5 mg tid after surgery,changed to ticagrelor 60 mg bid+ nicorandil 5 mg tid 6 months later).Follow-up was 12 months.The composite end points of cardiovascular death,myocardial infarction and stroke,the composite end points of mild hemorrhage,minor hemorrhage,other major hemorrhage and major fatal/life-threatening hemorrhage as defined by the PLATO study,and the composite end points of cardiovascular death,myocardial infarction,stroke and bleeding within 12 months in the two groups were observed.Results The comparison of general baseline data between the two groups showed no statistically significant difference(P>0.05).There was also no significant difference in the composite end points of cardiovascular death,myocardial infarction and stroke between the two groups(P>0.05).The cumulative incidence of bleeding events in ticagrelor de-escalation + nicorandil group was significantly lower than that in ticagrelor group(P<0.05),while the composite end points of cardiovascular death,myocardial infarction,stroke and bleeding were also significantly lower than those in tecagrelor group(P<0.05).Conclusion In elderly patients with ACS,the treatment of ticagrelor de-escalation + nicorandil after PCI may not increase the incidence of ischemic events such as cardiovascular death,myocardial infarction or stroke,and it may reduce the incidence of hemorrhagic events.

The effect of simultaneous coronary angiography and percutaneous coronary intervention versus selective percutaneous coronary intervention on the surgical success rate in treating coronary chronic total occlusion / 介入放射学杂志

Objective To discuss the effect of simultaneous coronary angiography plus percutaneous coronary intervention(PCI)and selective PCI on the surgical success rate in treating coronary chronic total occlusion(CTO).Methods The clinical data of a total of 147 consecutive patients with coronary CTO,who received PCI treatment at the Jinhua Municipal Central Hospital of China between January 1,2020 and December 31,2022,were retrospectively analyzed.According to whether the patient received PCI immediately after coronary angiography or not,the patients were divided into simultaneous PCI group(n=64)and selective PCI group(n=83).The clinical data and surgical success rate were compared between the two groups.Multivariate logistic regression analysis was used to determine the factors affecting the success of the PCI surgery for coronary CTO.Results The lesion's length of coronary CTO in the simultaneous PCI group was 35 mm,which was obviously shorter than 50 mm in the selective PCI group(P=0.022).No statistically significant differences in the other angiographic findings existed between the two groups(all P＞0.05).The surgical success rate in the simultaneous PCI group was 78.1%,which was remarkably lower than 88.0%in the selective PCI group(P=0.034).Multivariate logistic regression analysis revealed that simultaneous PCI(OR=4.617,95%CI=1.900-11.221,P=0.001),no stump lesion(OR=4.381,95%CI=1.821-10.452,P=0.001),occlusion length≥20 mm(OR=2.462,95%CI=1.030-5.887,P=0.043),and surgical complications(OR=8.688,95%CI=1.573-47.971,P=0.013)were the independent factors influencing the success of PCI surgery for coronary CTO.Conclusion For the treatment of coronary CTO,the simultaneous coronary angiography and PCI treatment may increase the risk of surgical failure.(J Intervent Radiol,2024,32:52-56)

Application of dynamic coronary roadmap in coronary artery low-dose mode / 介入放射学杂志

Objective To clarify whether the use of dynamic coronary artery roadmap(DCR)technology in a low-dose mode with 7.5 frames per second during coronary intervention can further reduce the total radiation dose,fluoroscopy time,and contrast agent usage.Methods A total of 94 patients,who received coronary angiography at the Shanghai Tongji Hospital of China between July 2022 and December 2022,were enrolled in this study.The patients were randomly divided into DCR group(n=53)and control group(n=41).DCR technology was used in the DCR group to guide the performance of percutaneous coronary intervention(PCI),while low-dose mode coronary angiography was adopted in the control group.The total air kerma(AK),dose-area product(DAP),intraoperative fluoroscopy time,and contrast agent usage were compared between the two groups.Results In the DCR group AK was(597.9±222.8)mGy,which was significantly lower than(717.0±326.8)mGy in the control group(P=0.039);DAP was(33.2±13.3)Gycm2/s,which was also remarkably lower than(41.3±21.5)Gycm2/s in the control group(P=0.027).In the DCR group and the control group,the intraoperative fluoroscopy time was(9.8± 3.3)min and(12.1±4.3)min respectively(P＜0.01),and the contrast agent usage was(122.3±19.0)mL and(130.5± 28.5)mL respectively(P=0.116).Conclusion In a low-dose mode during coronary intervention,the use of DCR technology can further reduce radiation dose,fluoroscopy time,and contrast agent usage.(J Intervent Radiol,2024,33:236-239)

Changes and significance of complement C1q/tumor necrosis factor-related protein-12 in serum of patients with acute myo-cardial infarction before and after percutaneous coronary intervention / 临床检验杂志

Objective To investigate the changes of C1q tumor necrosis factor-related protein-12(CTRP12)levels in serum of the pa-tients with acute myocardial infarction(AMI)before and after percutaneous coronary intervention(PCI),and explore its clinical sig-nificance.Methods A total of 50 patients with AMI who underwent emergency PCI and 35 patients with normal coronary angiography results in Danyang People's Hospital from November 2021 to October 2022 were enrolled.The CTRP12 levels in peripheral venous ser-um were compared between the two groups.The levels of serum CTRP12 levels were measured before,during and on the 3rd,5th and 7th day after PCI.The serum CTRP12 levels in culprit coronary ostium and peripheral vein were compared.CTRP12 levels in peripher-al venous serum were compared at different time points after PCI.The severity of coronary artery disease was evaluated by SYNTAX score system,and the AMI patients were divided into two groups:SYNTAX score ≤22 and SYNTAX score＞22.The serum CTRP12 levels were compared between the two groups and before and after PCI.The correlation between CTRP12 and age,body mass index(BMI),fasting blood glucose,blood lipid and other factors was analyzed.The influencing factors of the severity of coronary artery le-sions were analyzed by logistic regression.Results The serum CTRP12 level in the patients with AMI was significantly lower than that in healthy controls(P＜0.05).There was no significant difference between the serum CTRP12 levels between preoperative peripheral vein and intraoperative culprit coronary orifice(P＞0.05).Compared with that before PCI,the serum CTRP12 level was lower on the 3rd day after PCI(P＜0.05),and increased on the 5th and 7th days after PCI,but no statistically significant difference was found(P＞0.05).Compared with those on the 3rd day after PCI,the serum CTRP12 levels were increased on the 5th and 7th day after PCI,but no statistically significant differences were found(all P＞0.05).Compared with that in the SYNTAX≤22 group,the CTRP12 levels were significantly lower than those before PCI and on the 3rd day after PCI(all P＜0.05),while there was no significant difference on the 5th and 7th day after PCI in SYNTAX＞22 group(all P＞0.05).CTRP12 was negatively correlated with the level of total cholesterol(TC)and positively correlated with high-density lipoprotein cholesterol(HDL-C).Univariate logistic regression analysis showed that CTRP12 was an independent influencing factor for the severity of coronary artery disease in the patients with AMI(β=-1.671,OR=0.188,P＜0.05).After adjusting for the effects of age,gender,BMI,smoking,hypertension,diabetes,fasting blood glucose,total cholesterol(TC),triglyceride(TG),HDL-C and low-density lipoprotein cholesterol(LDL-C),CTRP12 was still an independent in-fluencing factor for the severity of coronary artery disease in the patients with AMI(β=-3.441,OR=0.032,P＜0.05).Conclusion The serum CTRP12 level was significantly decreased in the patients with AMI before PCI,and showed continuous decline on the 3rd day after PCI,but increased on the 5th and 7th day after PCI.CTRP12 should be an independent influencing factor for the severity of coronary artery disease in the patients with AMI.

Factors influencing dietary behaviors change of young and middle-aged patients after percutaneous coronary intervention: a qualitative study / 中国实用护理杂志

Objective:To explore the influencing factors of dietary behavior change of young and middle-aged patients after percutaneous coronary intervention (PCI) from the perspective of the family system, so as to provide the basis for home dietary intervention of patients.Methods:Using the phenomenological research method, 32 young and middle-aged PCI patients and their family members from Department of Cardiology, Xuanwu Hospital, Capital Medical University were interviewed in a semi-structured in-depth way by purposive sampling method from May to October 2022, and the data were analyzed by Colaizzi 7-step analysis method.Results:Among the 32 surveyed individuals, there were 17 males and 15 females, aged 22-61 years old. Two themes of dietary behavior change facilitators and barriers of young and middle-aged patients after PCI were extracted. The facilitators included six subthemes: behavioral autonomy, adaptive change, small family size, motivation for family responsibility, internal family resources, and external family resources. The barriers included five subthemes: bad learned habits, special physical conditions, lack of nutritional literacy, passive dietary environment, and limited economic level.Conclusions:Dietary behavior changes in young and middle-aged patients after PCI were affected by individual and family factors in the family. Medical staff should establish a family-centered dietary management model and integrate the advantages of family resources to give patients targeted individualized nutrition intervention.

Prognostic factors of patients undergoing percutaneous coronary intervention supported by extracorporeal membrane oxygenation / 实用医学杂志

Objective To explore the clinical value of transthoracic echocardiography(TTE)and related clinical indexesin the evaluation of percutaneous coronary intervention(PCI)supported by arteriovenous extracor-poreal membrane oxygenation(VA-ECMO)in the treatment of patients with acute myocardial ischemia complicated by refractory cardiogenic shock.Methods The clinical data of 70 patients with acute myocardial ischemia complicated by refractory cardiogenic shock treated with VA-ECMO in the First Hospital of Lanzhou University from January 2022 to April 2023 were analyzed retrospectively.According to the success of VA-ECMO withdrawal,the patients were divided into success group(54 cases)and failure group(16 cases).The general data,Intraoperative condi-tion,hemodynamic and biochemical indexes of the two groups were compared,and the independent risk factors affecting the clinical outcome were analyzed.Results The time of ECMO assistance in the success group was significantly shorter than that in the failure group(P<0.05).There was no significant difference inother general information between the two groups(all P>0.05).There was no significant difference in preoperative TIMI grade,number of diseased vascular branches,use of IVUS,ECG results and SYNTAX score between the two groups(all P>0.05).Compared with those before treatment,arterial oxygen saturation(SaO2),left ventricular stroke volume(LVSV),left ventricular ejection fraction(LVEF),mitral annulus systolic velocity(Sa),aortic orifice forward flow spectrum(AV),velocity-time integral(VTI)and tricuspid annulus systolic displacement(TAPSE)increased significantly after ECMO plus PCI treatment(all P<0.05).Left ventricular end systolic volume(LVESV)decreased significantly(P<0.05).Compared with those in the failure group,the heart rate(HR),shock index(SI),blood lactic acid(Lac),C-reactive protein(CRP),aspartate aminotransferase(AST)and total bilirubin(TBIL)were lower in the success group(all P<0.05).There was no significant difference in ECMO flow and SaO2 between the two groups(P>0.05).Univariate logistic regression analysis showed that ECMO-supporting time,HR,Lac,CRP,AST and TBIL were the influencing factors of weaning failure in patients with acute myocardial ischemia complicated with refractory cardiogenic shock.Conclusion VA-ECMO combined with PCI can significantly improve cardiac function in patients with acute myocardial ischemia complicated by refractory cardiogenic shock.Echocardiographic parameters(LVESV,LVSV,LVEF,Sa,AV,VTI,TAPSE)and clinical indexes(HR,Lac,CRP,AST,TBIL)have certain clinical value for theprognosis.