ABSTRACT
Introduction: Acute coronary syndrome (ACS) refers toa spectrum of clinical presentations ranging from those forST-segment elevation myocardial infarction (STEMI) topresentations found in non–ST-segment elevation myocardialinfarction (NSTEMI) or in unstable angina. Study aimedto investigate the current management of acute coronarysyndrome patients at a tertiary care centre at Kakinada andfocused on the guideline- adherence in the timing of invasivestrategies or choice of conservative treatment options duringadmission and at the time of discharge.Material and Methods: A retrospective, observational studyincluded 290 patients who presented with history of acutechest pain to our hospital within 12–hours of symptom onsetbetween January 2018 and December 2018 were included inthe study.Results: Patients were clinically followed for 12 months. Atotal of 290 patients, 260 ST elevation MI and 30 non-STelevation MI were included. The median compliance index(percentage of optimal compliance with guidelines) was 0.96(The value of p is 0.03301. The result is significant at p < .05.).By logistic regression risk score variable was independentlyrelated to mortality.Conclusion: A clear relationship between the extent ofguideline implementation, and 1-year mortality was shown andthis relationship remained strong after stratification on the riskscore at admission and the type of MI. This data emphasize theneed for thorough implementation of guidelines to improvethe outcome of patients suffering from acute MI.
ABSTRACT
Objective To investigate the prognostic risk factors of patients with acute inferior myocardial infarction and intra-operative occurrence of ventricular fibrillation (VF) when undergoing emergency percutaneous coronary intervention (PCI). Methods The data of 52 patients with acute inferior myocardial infarction treated in Cangzhou City People's Hospital from May 2016 to May 2018 were retrospectively analyzed, and they were divided into poor prognosis group (19 cases) and good prognosis group (33 cases) according to whether cardiovascular events occurred during 1 year of follow-up. The patients' gender, age, smoking or not, histories of diabetes, hypertension, hyperlipidemia, and the results of well performed color echocardiography within recent 3 days, such as left ventricular ejection fraction (LVEF), cardiac infarction size (IS), and coronary Gensini score were recorded in the two groups; the indicators with statistical significance in univariate analysis were included in the multivariate logistic regression analysis to screen out the prognostic risk factors of patients with acute inferior wall myocardial infarction undergoing emergency PCI and occurrence of intra-operative VF; Receiver operating characteristic (ROC) curve was drawn to evaluate the values of coronary Gensini score and IS in predicting intraoperative occurrence of VF in patients with acute inferior wall myocardial infarction undergoing emergency PCI. Results During 1-year follow-up, 19 of 52 patients with acute inferior myocardial infarction occurred VF, the incidence being 36.5%. The univariate analysis showed that the IS and Gensini score in poor prognosis group were significantly higher than those in the good prognosis group [IS: (3.2±0.2)% vs. (2.5±0.4)%, Gensini score: 98.8±12.5 vs. 85.7±8.4, both P < 0.05], the LVEF level was significantly lower in the poor prognosis group than that in the good prognosis group (0.37±0.08 vs. 0.46±0.11, P < 0.05). The multivariate Logistic regression analysis showed that IS [odds ratio (OR) = 5.016] and coronary Gensini score (OR = 2.415) were the risk factors of occurrence of cardiovascular events after surgery in patients with acute inferior myocardial infarction and intra-operative VF when undergoing PCI (P < 0.05). The ROC curve analysis showed that IS and coronary Gensini scores had certain predictive values for the prognosis of patients with acute inferior myocardial infarction and occurrence of intra-operative VF when undergoing emergency PCI, the area under the ROC curve (AUC) was 0.863 and 0.597, respectively, indicating that IS had a medium predictive value, while the value of coronary Gensini score was lower, when the IS optimal cut off value was 3.0, the sensitivity was 89.4% and the specificity was 88.0%. Conclusion High IS and Gensini score are the risk factors of prognosis of patients with acute inferior myocardial infarction and intra-operative occurrence of VF when undergoing emergency PCI.
ABSTRACT
Objective To probe into impacts of safflor yellow injection on rats with acute myocardial infarction and discuss its mechanism. Methods Forty Sprague-Dawley rats were divided into sham operation group ( 8 rats ) and operation groups(32 rats).The left anterior descending branch of coronary artery was ligated to establish an animal model with acute myocardial infarction.The rats with successful modeling were randomly divided into model control group, 3-, 7- and 14-days safflor yellow group.In the treatment group, the rats were injected with safflor yellow injection(2.5 mg.kg-1.d-1)for 3, 7 and 14 days, respectively.Rats in sham operation and model control group were injected 0.9% sodium chloride solution.Their weights were measured 24 h after the last drug administration, their hearts were removed, and the serum was obtained through centrifugation.The enzymic method was used to measure the lactate dehydrogenase(LDH)and creatine kinase(CK)contents of serum.Hematoxylin eosiny(HE)staining method was used to observe the change of myocardial cells.The chloride three phenyl-tetrazole( TTC) staining method was used to measure the area of myocardial infarction in the rats. The real-time fluorescent quantitative PCR method was used to measure the expression of VEGF and HIF mRNA at the marginal zone of myocardial infarction. Results The levels of LDH and CK were(106.12±35.52),(452.84±60.38)mmol.L-1 in sham operation group, and(385.66±137.58),(2 111.00±1 250.80)mmol.L-1 in model control group.LDH in 3-, 7-, 14-days treatment groups was (249.66±51.86),(104.33±51.08),(110.33±26.76)mmol.L-1, while CK was(1 713.00±584.74),(1 177.66±980.18), (421.33±54.60)mmol.L-1.LDH and CK levels of the 14-days treatment group were significantly lower than those in the model control group(both P<0.05).The area of myocardial infarction was (0.00±0.00)% in sham operation group,(13.12±6.69)% in the model control group, and(8.11±3.45)%,(7.01±2.98)%,(3.44±1.17)% in the 3-, 7-, 14-days treatment groups.The area of myocardial infarction in the 14-days treatment group was significantly lower than that of the model control group(P<0.05).The expression of VEGF and HIF mRNA was 1.99±0.27, 6.21±1.35 in the sham operation group, 1.03±0.15, 1.78±0.57 in the model control group.The expression of HIF mRNA in the 3-, 7-, 14-days treatment groups was 0.50±0.12, 1.23±0.24, 2.20± 0.32, and the expression of VEGF mRNA in the 3-, 7-, 14-days treatment groups was 0.43±1.27, 2.67±0.83, 5.78±1.23. Conclusion The safflor yellow injection has therapeutical effects on the rats with acute myocardial infarction, and the effects will become significant after 14 day.It can reduce the area of myocardial infarction and LDH and CK content at the drug administration groups, which might be related to the increase of the expression of VEGF and HIF mRNA.
ABSTRACT
Objective To explore the impact of hyperglycemia on Hypersensitive C-reaction protein (hsCRP),B-type natriuretic peptide(BNP) and ventricular remodeling in elder patients with acute myocardial infarction(AMI).Methods One hundred and twenty elder patients with AMI are divided into hyperglycemia group(blood sugar in admission ＞ 7.8 mmol/L) and non-glycemia group(blood sugar in admission ≤7.8 mmol/L).The levels of blood sugar in admission,hsCRP,BNP were detected.LVEF,LVEDD,LVESD,WMS were observed by cardiac echo in admission and two weeks after therapy.Results The blood sugar in admission,hsCRP and BNP of the patients in hyperglycemia group were (9.6 ± 0.6) mmol/L,(1 750.6 ±677.1) ng/L,(56.1 ±38.6) ng/L,higher than those in non-glycemia group (t =38.679 and P =0.000; t =11.941 and P =0.000; t =3.288 and P ＜0.01,respectively).LVEF,LVEDD,LVESD and WMS of patients in hyperglycemia group didn't show statistical significance before and after therapy.However,there were significant in hyperglycemia group (t =2.049 and P =0.043,t =2.836 and P =0.005,t =3.814 and P =0.000,t =2.086 and P =0.039,respectively).Conclusion Hyperglycemia can reduce the increase of hsCRP and BNP,which has an impact on hsCRP,BNP and ventricular remodeling in elder patients with acute myocardial infarction,but the mechanism need to further research.
ABSTRACT
Objective To investigate the effect of early application of aldosterone receptor blockade-spironolactone on cardiac remodeling in patients with acute myocardial infarction.Methods A total of 616 patients were enrolled in this prospective study,who were admitted to the CCU Division of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010.Inclusive criteria were as follows:First-onset STEMI according to the diagnostic criteria in ST-segment elevation acutemyocardial infarction diagnosis and treatment guidelines and admitted within 24 hours from onset.Exclusive criteria were as follows:Non-STEMI,only right ventricular infarction and old myocardial infarction; cardiac function Killip Class Ⅳ or hypotensive state; renal dysfunction(serum creatinine ＞ 221 μmol / L); serum potassium ＞5.0 mmol / L; longer than 24 hours from onset and older than 75 years of age.All the patients were randomly divided into a control group of standard therapy and a treatment group of standard therapy combined with spironolactone 20 mg per day.Totally 528 patients were observed completely,including 266 patients in the control group and 262 patients in the treatment group.There was no statistical difference of clinical characteristics between the two groups,including age,gender,past medical history,admission situation,and treatment(P ＞ 0.05).The effect of spironolactone on cardiac remodeling、left ventricular function、renal function and blood levels of potassium were evaluated by detecting echocardiography,serum potassium and serum creatinine at one month and one year follow-up.Results Compared with the control group,the echocardiography indicators such as LVESD,LVEDD,LVEF,LAD-ML and LAD-SI were significantly improved in treatment group at one year(P ＜ 0.05).In treatment group,LVESD,LVEDD,LVPWT,LVEF,LAD-ML and LAD-SI were significantly improved at one year than one month(P ＜ 0.05,and P =0.007 to LVEF),and LVEF was significantly improved at one year than one month in control group(P =0.0277).There were no statistical differences of serum potassium and serum creatinine between the two groups.Conclusions On the basis of conventional treatment,the early combination of low dose spironolactone(20 mg/d)could inhibit cardiac remodeling at late stage and prevent heart failure.
ABSTRACT
BACKGROUND/AIMS: Acute myocardial infarction (AMI) is a leading cause of death. Inflammatory processes play an important role in atherosclerosis, which is intimately related to AMI. The aim of this study was to investigate the association between anti-inflammatory and pro-inflammatory cytokines ratios and AMI. METHODS: A total of 90 AMI patients and 90 age-and sex-matched controls were recruited in this study. Plasma cytokines and conventional risk factors were determined by standard methods. RESULTS: Patients with AMI showed increased interleukin (IL)-6 and tumor necrosis factor-alpha levels and lower anti- to pro-inflammatory cytokine ratios as compared with controls. A multivariate logistic regression analysis revealed that IL-10 to IL-6 ratio was independently associated with the occurrence of AMI (odds ratio [OR], 5.39; 95% confidence interval [CI], 2.39 to 12.17; p < 0.0001). In contrast, IL-6 levels were no longer significant in the multivariate model (OR, 1.02; 95% CI, 0.932 to 1.12; p = 0.603). A receiver operating characteristic (ROC) curve analysis indicated that IL-6 levels and IL-10 to IL-6 ratios were a significant predictor of AMI (area under ROC curve, 0.892 and 0.851, respectively). CONCLUSIONS: Our results suggest that the ratio of IL-10 to IL-6 is independently associated with AMI, and reduced levels of this ratio may favor the development of AMI.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Atherosclerosis/blood , Interleukin-10/blood , Interleukin-6/blood , Logistic Models , Multivariate Analysis , Myocardial Infarction/blood , Predictive Value of Tests , ROC Curve , Risk FactorsABSTRACT
Justificativa e objetivos: Vários estudos mostram o valor da proteína C-reativa (PCR) na avaliação de pacientes com doença cardiovascular prévia ou fatores de risco, porém, não há um consenso das sociedades científicas quanto à aplicação deste marcador para avaliação destes pacientes no evento agudo. O objetivo deste estudo foi avaliar os níveis de PCR e perfil lipídico em pacientes na fase aguda de infarto agudo do miocárdio (IAM). Método: Foram avaliados 36 pacientes atendidos em emergência cardiológica entre maio e junho de 2007. Foram dosadas PCR de alta sensibilidade (PCR-as) por método imunoturbidimétrico e perfil lipídico. Resultados: Amostra composta de 83,4% de pacientes do sexo masculino e idade média de 62 anos. Aproximadamente 75% dos pacientes eram portadores de hipertensão arterial sistêmica (HAS), 66,6% tabagistas, 33,3% com história prévia de doença coronariana (DAC) e 30,5% portadores de diabetes mellitus (DM). O IAM sem elevação do segmento ST (IAMSEST) representou 58,3% dos casos. Foram registrados 72,2% pacientes com valores de PCR-as > 3 mg/L. O IAMSEST esteve associado com maiores níveis de PCR-as em relação ao IAM com elevação do segmento ST. Tabagistas e pacientes com DAC prévia tiveram maiores médias de PCR-as, não sendo observada relação estatística entre HAS ou DM com este marcador inflamatório. Os níveis de PCR-as foram maiores nos grupos com colesterol total e LDL-colesterol aumentados. Conclusão: Estes resultados indicam que os pacientes apresentam altos valores da PCR-as na fase aguda do IAM. Observou-se que o IAMSEST, história de tabagismo ou DAC prévia, colesterol total e LDL-colesterol aumentados relacionam-se com valores maiores da PCR-as, tendo estes grupos maior status inflamatório.
Background and objectives: Many studies show the value of C-reactive protein (CRP) in assessment of patients with previous cardiovascular disease or risk factors, but, there is no agreement of scientific societies about the use of this marker to assess these patients on acute event. The objective of this study was assessing CRP levels and lipid profile in patients with acute myocardial infarction (AMI). Method: Have been appraised 36 patients attended on cardiologic emergency among May and June of 2007. We accessed clinical profile, dosages of high sensitivity CRP (hs- CRP) by imunoturbidimetric method and profile lipid. Results: Pattern was built up from 83.4% of patients of male gender and median-age about 62 years. Approximately 75% patients had arterial hypertension (SAH), 66.6% smokers, 33.3% with previous history of coronary disease (CAD) and 30.5% had diabetes mellitus (DM). Non-STsegment elevation AMI (NSTSEAMI) was 58.3% of the cases. Have been registered 72.2% patients with hs-CPR levels higher than 3mg/L. NSTSEAMI was associate with higher levels of hs-CPR when compared with AMI with ST-segment elevation. Smokers and previous CAD patients had higher median of hs-CPR levels, no being observed statistics relation between SAH and DM with this inflammatory marker. The hs-CRP levels were higher in groups of higher levels of total cholesterol and LDL-cholesterol. Conclusion: These results indicate that patient present elevated hs-CPR levels in AMI. Also, NSTSEAMI, smokers, previous CAD, high levels of total cholesterol and LDL-cholesterol are related to higher hs-CRP levels, being these groups under major inflammatory status.
Subject(s)
Humans , Male , Female , Aged , C-Reactive Protein , Myocardial InfarctionABSTRACT
Objective To evaluate the clinical effectiveness of a new and easy-to-use thrombus-aspirating device for primary percutaneous trans-radial coronary intervention (PCI). Method From March 2006 to June 2008, fifty acute myocardial infarction (AMI) patients with angiographic evidence of high-burden coronary throm-bus treated with thrombus aspiration were enrolled in a single center retrospective study. Thrombotic clot was aspi-rated before stent was implanted in the infarct-related coronary artery. Thrombolysis in myocardial infarction(TIMI) flow, corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade(TMPG), and rate of no-reflow were observed with coronary augiography. Acute thrombosis and subacute thrombosis in stent during hospital stay were investigated. Myocardial ischemic events, revascularization and mortality during the following period were also in-vestigated. Paired t -test was used for statistical analysis. Results Thrombus was completely removed in 35 pa-tients (70%) and partially removed in 15 patients (30%) seen immediately after thrombus aspiration. There were significant improvements both in postoperative TIMI flow (0 vs. 2.7±0.5, P <0.01) and TMPG (0 vs. 2.6±0.8, P <0.01), while cTFC was 20.2±16.8 after the thrombus aspiration. No severe complication occurred during and after operation. Conclusions Trans-radial thrombas-aspiration in primary PCI is clinically safe and feasible. The use of aspiration catheter (ZEEK) is a simple and effective approach to the treatment of coronary artery stenosis associated with thrombus because it elevates the successful rate of treatment,reduces the incidence of no-reflow,and results in better prolonged-term outcome.
ABSTRACT
Objective To evaluate the effects of socioeconomic status on the distribution of cardiovascular risk factors and clinical treatments of patients with acute myocardial infarction in Beijing.Methods In Beijing, a prospective, muhi-center, registration study was carried out which including 800 patients who were consecutively hospitalized for ST-segment elevation acute myocardial infarction within 24 hours after event attack in 19 different hospitals in Beijing between November, 2005 and December, 2006.Indicators of socioeconomic status included self-reported personal income (＜500, 500-2000,＞2000 RMB/month), educational attainment (≤ 12 and ＞ 12 years) and status of medical insurance (yes/no).According to categories of education, patients were categorized into two groups of lower socioeconomic status and higher socioeconomic status. Differences of cardiovascular risk factors and clinical treatments were compared across the two groups respectively. Results Proportion of diabetes and hyperlipidemia in patients with higher socioeconomic status was much higher than that of patients with lower socioeconomic status (P＜0.05, P＜0.01 respectively). Patients with lower socioeconomic status were more likely to be smokers (P ＜0.05). The rates of receiving coronary angiography and PTCA were much lower in patients with lower socioeconomic status. Medical insurance and income were the most important two socioeconomic factors determining the use of PTCA. Conclusion Compared to patients with lower socioeconomic status,patients with higher socioeconomic status had higher rates of hyperlipidemia and diabetes but lower smoking rate among cardiovascular risk factors. The rates of receiving interventional therapies were much lower in patients with lower socioeconomic status.
ABSTRACT
Objective To observe the effectiveness and safety of clopidogrel combined with fibrinolytic therapy for acute ST segment elevation myocardial infarction(STEMI).Methods From January 2004 to December 2006,a total of 158 STEMI patients in our hospital were treated with fibrinolytic agents combined with or without clopidogrel.There were 84 patients in clopidogrel group,including 66(78.6%)male,18(21.4%)female and 45(53.6%)elderly patients(aged ≥ 60 years);74 patients were in control group,including 58(78.4%)male,16 female(21.6%)and 40(54.1%)elderly patients.Clinical characteristics,patency of infarct-related artery(IRA),30 d major adverse cardiac events(MACE),recurrent angina and hemorrhage events of the two groups were retrospectively analyzed.Efficacy and safety of fibrinolytic therapy combined with clopidogrel in elderly patients(≥60 years old)subgroup were also estimated.Results Baseline clinical characteristics between the two groups were comparable.Clopidogrel therapy was associated with a higher proportion of patent IRA(69.1% vs 51.4%,P=0.035)and lower rates of cardiac death(0 vs 6.8%,P=0.047)and MACE(2.4% vs 12.2%,P=0.036).There was no significant difference in the incidence of recurrent angina(3.6% vs 2.7%,P=0.885),slight and severe hemorrhage events(7.1% vs 9.5%,P=0.811;1.2% vs 1.4%,P=0.533)between the two groups.In elderly patients,clopidogrel therapy was associated with a higher proportion of patent IRA(68.9% vs 45.0%,P=0.045),the declining tendency in MACE(2.2% vs 12.5%,P=0.155),but no significant differences in the other indexes.There were no significant differences in above-mentioned indexes between the elderly and younger patients in clopidogrel group.Conclusion Addition of clopidogrel to fibrinolytic therapy is safe and effective for both the elderly and younger STEMI patients.
ABSTRACT
Objective To investigate the feasibility,safety and efficacy of sirolimus-eluting stent implanting in diabetic patients with ST-segment elevation myocardial infarction(STEMI)treated by emergency percutaneous coronary intervention(PCI).Methods One hundred and six diabetic patients with STEMI treated by emergency PCI were included into this study.The incidence of major adverse cardiovascular event(MACE),stent thrombosis and restenosis was evaluated.Results Totally 105 patients were successfully treated by emergency PCI and there were no complication during the procedure.Totally 134 sirolimus-eluting stents were successfully implanted on 110 target lesions.There was one subacute stent thrombosis in 106 patients during one month.One-month follow-up result showed that the MACE was 4.72% and the death rate was 3.77%.The MACE was 10.38% and the death rate was 3.77% one year later.One-year angiography follow-up showed that restenosis rate was 11.54%.Conclusion Implanting sirolimus-eluting stent in STEMI patients during emergency PCI is safe and effective.Sirolimus-eluting stent can reduce restenosis rate and MACE in diabetic patients with STEMI treated by emergency PCI.
ABSTRACT
Objectives To compare the in-hospital outcomes of elderly patients with acute myocardial infarction (AMI)treated by interventional or conservative protocols. Patients and Methods One handred and seventy-six consecutive patients hospitalized for AMI were involved, including 95 patients underwent emergent percutaneous coronary intervention (PCI) within 24 h after the onset of AMI and 81 patients received conservative non-invasive therapies.Clinical characteristics and in-hospital cardiac events of these two divisions were analyzed. Results In the PCI group, success rate of procedure and lesions was 98.9% and 98.5%, respectively. Procedure related complication were occurred in 6 cases(6.3%) and no patient died during operative procedures. PCI group had a lower in-hospital mortality (11.6% vs 24.7%, P＜0.05) and overall cardiac events rate (2A.2%vs56.8%, P＜0.01) compared with conservative group. Patients complicated by pump failure at admission in PCI group had a lower mortality compared with their counterpart in conservative group(27.3% vs 60.9%, P＜0.05). The average hospital duration between the two groups was no significant differences. The coronary care unit (CCU) duration of the PCI group was less than that of conservative group (4±5d vs 8±5d, P＜0.05). Conclusions In elderly patients with AMI, interventional treatment can significantly decrease the in-hospital mortality and cardiac events rate compared with conservative treatment, thus gains a better short-term outcome.
ABSTRACT
Objective To determine the changes of L-type calcium currents(I Ca-L ) of rabbit ischemic myocytes in peri-infarcted zone.Methods Rabbit AMI models were made by ligation of branches of left coronary artery. After 1 week and 2 months, single pericardial myocytes were isolated enzymatically from ischemic zone adjacent to infarcted area and the normal control cells from similar regions in normal rabbit hearts. I Ca-L were recorded by using patch clamp techniques in the whole cell configuration. Results Peak of I Ca-L density of ischemic cells from the peri-infarcted zone was significantly reduced in AMI onc week later ( 3 52 0 93 pA/pF, n=6) compared to control cells ( 5 58 1 53pA/pF,n=10), P0 05 The steady-state inactivation curves were shifted to the hyperpolarizing direction in ischemic cells,the half-maximal voltage dependence of inactivation(V 1/2 ) in ischemic cells was 25 9 7 0 mV in AMI 1W , 21 3 5 6mV in AMI 2M and 13 1 4 2mV in the control cells(compared with control group,P
ABSTRACT
Objective:To study the mechanism and clinical significance of the precordial ST segment deviations in acute inferiorwall myocardial infarction (AIMI) involving adjacent area. Methods: Characteristics of electrocardiogram were analyzed in118 patients with AIMI. Results: (1)The magnitude of ST segment elevation of inferior wall leads (Ⅱ, Ⅲ and aVF) wassignificantly negatively correlated with that of precordial leads (P＜0.01). (2)The changed magnitude of ST segment oflead V2 (0.63±1.82 mm) and V2/aVF ratio (0.84±1.61) in 16 cases associated with right ventricular infarction weresignificantly higher than those of only inferior wall myocardial infarction group (V2:0.35±1.65 mm,V2/aVF ratio:0.29±1.28)(P＞0.05 and P＞0.05). (3)The magnitude of ST segment fall of lead V2(-1.20±1.52 mm) and V2/aVFratio (-0.33±1.15) in 38 cases associated with lateral-posterior wall in farction were higher than those of only inferiorwall infarction group (P＜0.05). (4)If the cases associated with right ventricular and lateral-posterior wall infarction werenot included, the ST segment correlation coefficient between inferior and precordial leads would significantly increase inAIMI (r =-0.797, P＜0.01). Conclusion:The directions of ST segment deviations of precordial leads elevate in casesassociated with right ventricular infarction and fall in eases associated with lateral-posterior wall infarction in AIMI.
ABSTRACT
To assess the early results, risk factors and optimal timing for coronary artery bypass graft surgery(CABG) after an acute myocardial infarction(AMI), we reviewed our 19 patients who underwent CABG within 30 days after AMI, between June 1994 and October 1996. This study excluded 1 patient whose diagnosis was AMI with ventricular septal rupture. 14 of the patients were male and 5 were female. Their ages ranged from 41 to 77 years(mean age, 60.6+/-10.4 years), and the amount of time between AMI and CABG ranged from 8 hours to 24 days(mean time, 10.6+/-6.4 days). There were 11 anteroseptal infarctions and 8 inferior wall infarctions. 11 patients had transmural infarctions and 8 had subendocardial infarctions. Indications of operations were primary revascularization and postinfarction angina. Three patients required preoperative intra-aortic balloon pump(IABP) support, and 4 additional patients required IABP to be separated from cardiopulmonary bypass. An average of 3.6+/-0.6 vessels per patient were bypassed. The early mortality rate for these 19 patients was 5.3% and late mortality rate was 5.5%, 1-year and 2-year actuarial survival rates were 89.5%. Univariate analysis of mortality showed that an ejection fraction less than 30% and intraopretative IABP supports were associated with risk factors(p value=0.018 and 0.015 respectively). Age, sex, time to CABG, emergency operations, types and locations of infarctions were not significant. Although our studies have weak points in that there was only a small number of patients and the lack of long-term results, we could conclude that early myocardial revascularization is relatively safe after AMI for those individuals with an ejection fraction greater than 30%.
Subject(s)
Female , Humans , Male , Cardiopulmonary Bypass , Coronary Artery Bypass , Diagnosis , Emergencies , Infarction , Mortality , Myocardial Infarction , Myocardial Revascularization , Risk Factors , Survival Rate , Transplants , Ventricular Septal RuptureABSTRACT
Objective To evaluate the efficiency and safety of Percusurge guardwire distal protection system in coronary intervention in patients with acute myocardial infarction. Methods Three male patients with acute myocardial infarction were enrolled in the study. Primary angioplasty was performed for 2 of them, 2 and 7 hours after onset of the infarction symptom, respectively. Selective angioplasty was performed 17 days after infarction for the third case. Percusurge guardwire system was used during the procedure. Results Procedure success was achieved for all of the 3 cases. Lot of thrombus was sucked out. The infarct-related arteries had TIMI 3 flow at the end of the procedures. The patients′ symptoms were resolved soon after the procedure. Minor dissection was seen in one case which did not obstruct the distal flow and was left alone. Conclusion Percusurge guardwire system can be used safely and effectively in coronary intervention in the thrombus-laden arteries such as acute myocardial infarction.
ABSTRACT
Objective To study the effects of diabetes mellitus(DM)on fas receptor-induced cardiomyocytes apoptosis and inflammatory response in patients with acute myocardial infarction(AMI).Methods 70 patients with ST-elevated myocardial infarction were divided into two groups:without(n=36)and with diabetes mellitus(n=34).Strepavidin-biotin ELISA was used to examine the serum levels of sFas,sFasL,TNF-? and IL-6.Results As the concentrations of sFas and sFasL immediately after primary PCI were higher in patients of AMI with DM than without DM(4.18?0.86 vs 3.30?0.82 ng/ml,6.15?1.56 vs 4.34?1.37 ng/ml,respectively,P
ABSTRACT
Objective To evaluate the short term and long term outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) for acute anterior wall myocardial infarction (AMI) complicated with pump failure Methods 28 patients admitted within 12 hours after the onset of AMI and complicated with heart failure underwent primary PTCA and stent implantation The short term and long term therapeutic effects were observed Results The infarct related coronary arteries (IRCA) of the 28 patients were all LADs with occlusions at the proximal or beginning segment and TIMI flow was 0 Ⅰ Single vessel disease was showed in 15 patients,double vessel disease in 9 and triple vessel disease in 4 The immediate procedural success rate was 100% with TIMI flow Ⅲ in all IRCAs One patient without stent implantation had a recurrent chest pain 2 days after procedure and died of acute pulmonary edema During 1～36 month follow up of the 27 survivors, no death occured and the average LVEF was showed 59 8?6 5% by echocardiography Conclusion Primary PTCA for AMI complicated with pump failure was safe and effective to improve the short term and long term outcomes
ABSTRACT
Therapeutic effects of complex nucleosides were studied by using two models of heart failure caused by either the ligation of the anterior interventricular branch of the coronary ar- tery in anesthetized dogs or iv injection of a mixed solution of verapamil and propranolol (0.5mg/Kg respectively)in anesthetized rats.After iv complex uncleosides 0.5mg/Kg/min for 10 min in the dogs and 5 mg/Kg/min for 4 min in the rats,a positive inotropic effect and an increase of cardiac output were observed,but no influence on the peripheral resistance,myocardial oxygen consumption and heart rate.Complex nucleosides had no effect on the S-T segment elevation due to the myocardial ischemic injury.On a rat model of verapamil and propranolol-induced heart failure dopamine 2 mg/Kg iv showed cardiovascular effects,which is similar to complex nucleosides.