Shock cardiogénico en el contexto de los síndromes coronarios agudos en Argentina: resultados del Registro ARGEN SHOCK 2 / Cardiogenic Shock in the Setting of Acute Coronary Syndromes in Argentina: Results from the ARGEN SHOCK 2 Registry

RESUMEN El shock cardiogénico (SC) es una complicación grave del infarto agudo de miocardio (IAM) y constituye una de sus principales causas de muerte. Objetivos: Conocer las características clínicas, estrategias de tratamiento, evolución intrahospitalaria y mortalidad a 30 días del SC en Argentina. Material y métodos: Se trata de un registro prospectivo, multicéntrico, de pacientes internados con SC en el contexto de los IAM con y sin elevación del segmento ST durante 14 meses (1 de agosto 2021 al 30 de septiembre 2022) en 23 centros de Argentina. Resultados: Se incluyeron 114 pacientes, edad 64 (58-73) años, 72% hombres. El 76,3% de los casos corresponden a IAM con elevación del segmento ST, 12,3% a IAM sin elevación del segmento ST, el 7% a infarto de ventrículo derecho y el 4,4% a complicaciones mecánicas. El SC estuvo presente desde el ingreso en el 66,6% de los casos. Revascularización: 91,1%, uso de inotrópicos: 98,2%, asistencia respiratoria mecánica: 59,6%, SwanGanz: 33,3%, balón de contrapulsación intraaórtico: 30,1%. La mortalidad intrahospitalaria global fue 60,5%, sin diferencias entre los IAM con o sin elevación del segmento ST, y a 30 días del 62,6%. Conclusiones: La morbimortalidad del SC es muy elevada a pesar de la alta tasa de reperfusión empleada.

ABSTRACT Background: Cardiogenic shock (CS) is a life-threatening complication of acute myocardial infarction (AMI) and constitutes one of the leading causes of death. Objective: The aim of this study was to investigate the clinical characteristics, treatment strategies, hospital outcome and 30-day mortality of CS in Argentina. Methods: We conducted a prospective, and multicenter registry of patients with acute myocardial infarction (AMI) with and without ST-segment elevation complicated with CS that were hospitalized in 23 centers in Argentina for 14 months (between August 1, 2021, and September 30, 2022). Results: The cohort was made up of 114 patients; median age was 64 years (58-73) and 72% were women; 76.3% corresponded to ST-segment elevation AMI, 12.3% to non-ST-segment elevation AMI, 7% had right ventricular infarction and 4.4% had mechanical complications. In 66.6% of cases CS was present on admission. Revascularization: 91.1%, use of inotropic agents: 98.2%, mechanical ventilation: 59.6%, Swan-Ganz catheter: 33.3%, intra-aortic balloon pump: 30.1%. Overall in-hospital mortality was 60.5%, with no differences between AMI with or without ST-segment elevation, and was 62.6% at 30 days. Conclusion: Morbidity and mortality of CS are high despite the high rate of reperfusion therapy used.

Prediction of adverse cardiac outcomes in high-risk Mexican patients with chest pain in the emergency department / Desenlaces adversos cardiovasculares en pacientes mexicanos de alto riesgo con dolor torácico en el servicio de urgencias

Abstract Objective: The aim of the study was to compare the discriminative power and accuracy for prediction of MACE of five commonly used scoring tools in Mexican patients with chest pain who present to the ED. Methods: A single-center, prospective, observational, and comparative study of patients admitted to the ED with chest pain as the chief complaint. Five chest pain scoring systems were calculated. The primary endpoint was the composite of cardiovascular death, myocardial infarction, coronary intervention, coronary artery bypass grafting, or readmission for cardiovascular causes within 30 days. Results: A total of 168 patients were studied. The score which provided the highest area under the curve of 0.76 (95% CI: 0.70-0.85) was history, ECG, age, risk factors, and troponin (HEART) score. In addition, the integrated discrimination index for the HEART score was 6% higher when compared to the other four scores. Conclusions: The HEART score provided the best classification tool for identifying those patients at highest risk for MACE, either alone or by adding their results to other classification scores, even in a comorbid population.

Resumen Objetivo: Comparar el poder discriminativo y precisión diagnóstica de Eventos Cardiovasculares Mayores (ECVM) de cinco escalas de clasificación de dolor torácico de uso común en pacientes mexicanos con dolor torácico que acuden al servicio de urgencias. Métodos: Estudio prospectivo, observacional y comparativo que incluyó a pacientes ingresados en urgencias que presentaban dolor torácico como síntoma cardinal. Se calcularon cinco escalas de puntuación de dolor torácico. El desenlance principal fue el compuesto de muerte cardiovascular, infarto de miocardio, intervención coronaria, injerto de derivación de arteria coronaria o reingreso por causas cardiovasculares dentro de los 30 días. Resultados: Se estudió un total de 168 pacientes. La escala de puntuación que proporcionó el área bajo la curva más alta de 0.76 (IC de 95%: 0.70-0.85) fue la escala de historia clínica, ECG, edad, factores de riesgo y troponina (HEART, por sus siglas en inglés). Además, el indice de discriminación efectiva para la puntuación HEART fue un 6% más alto en comparación con las otras cuatro escalas de puntuación. Conclusiones: La escala de HEART proporcionó la mejor herramienta de clasificación para idenfiticar a los pacientes con mayor riesgo de ECVM, ya sea solo a agregando sus resultados a otros puntajes de clasificación, incluso en una población comórbida.

Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

The research status and progress of ocular manifestations related to acute coronary syndromes / 中华眼底病杂志

Acute coronary syndromes (ACS) are clinical syndromes caused by the instability or rupture of coronary atheromatous plaques. The development and treatment of ACS are closely related to some ocular manifestations. Hypertensive retinopathy, retinal arteriovenous occlusion, diabetes retinopathy, and age-related macular degeneration are associated with a high risk of ACS. Retinal vascular occlusion may be a potential postoperative complication of the percutaneous coronary intervention for ACS. Ocular parameters such as the retinal vascular diameter and density, the blood flow velocity of the ophthalmic artery, and the choroidal thickness are expected to be markers for assessing or predicting the risk of ACS, which are of important value for the prevention of cardiovascular events such as ACS.

Speckle Tracking in Acute Non-St Elevation Acute Coronary Syndromes Patients as a Factor of Risk Stratification

Background: Coronary artery disease (CAD) early diagnosis remains a clinical problem in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), especially in the regional wall motion abnormalities’ absence on presentation by Echo. This study assessed the relationship between ECG changes and speckle Tracking in subjects with acute NSTE-ACS. Methods: This prospective trial was performed on 100 subjects with NSTE-ACS. All subjects were subjected to laboratory tests [complete blood picture, renal function test, liver test profile, lipid profile, RBS and cardiac biomarkers (cardiac troponin, creatinine kinase and CK-MB)], 12 lead ECG, Echocardiography (TTE, speckle tracking), Image analysis and coronary angiography. Results: regarding IVRT, TDI e`, TDI a`, a considerable difference between the two groups were found. DBP was considerably lower in STD group in comparison with TWI group (P value= 0.047). IVRT, TDI a` and GLS were considerably higher in STD group in comparison with TWI group (P value= 0.024, 0.031, 0.003 respectively). Conclusions: Speckle tracking could be used as part of standard echo for the examination of individuals suffering from NSTE-ACS.

Muerte Súbita Post Infarto: ¿Cuándo Implantar un Desfibrilador Automático? Breve revisión a propósito de un caso / Sudden Death After Infarction: when To Implant An Automatic Defibrillator? Brief review about a case

Sudden death is the most serious complication of acute coronary syndromes. The highest percentage occurs at home with a very low survival rate. The highest risk group are patients with ejection fraction under 40% after an acute myocardial infarction. So far the indication of the clinical practice guides are the implantation of ICD as a secondary prevention, and as a primary prevention when the systolic function is severely diminished, however there is an interval of 40 days in which the implant has not managed to demonstrate benefits. In this critical period patients should be managed with beta-blockers. So far, the absolute benefit of using portable cardioverter-defibrillators as a prophylactic bridge to the ICD implant has not been demonstrated. The following revision is based on the most relevant clinical practice guides in the field carried out in relation to a clinical case

COVID-19 and the Heart / COVID-19 y el corazón

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) has resulted in a global health crisis. Prior to the arrival of this viral pandemic, the world was already plagued with a significant burden of cardiovascular disease. With the introduction of the novel virus, the world now faces a double jeapordy. Early reports have suggested an increased risk of death in individuals with underlying cardio-metabolic disorders. The exact effects of COVID-19 on the cardiovascular system are not well determined, however lessons from prior viral epidemics suggest that such infections can trigger acute coronary syndromes, arrhythmias and heart failure via direct and indirect mechanisms. In this article, we aimed to discuss the effects and potential underlying mechanisms of COVID -19 as well as potential implications of treatments targeted against this virus on the cardiovascular system.

Resumen El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19) ha provocado una crisis en la salud global. Antes de la llegada de esta pandemia, se tenia una carga importante de enfermedad cardiovascular a nivel mundial. Con la introducción del nuevo virus, el mundo ahora se enfrenta a un doble peligro. Los primeros informes han sugerido un mayor riesgo de muerte en personas con trastornos cardio-metabólicos de base. Los efectos causados por el COVID-19, en el sistema cardiovascular aun no están bien determinados, sin embargo, el conocimiento sobre otras epidemias virales previamente ocurridas en el mundo, sugieren que estas infecciones pueden desencadenar síndromes coronarios agudos, arritmias e insuficiencia cardíaca a través de mecanismos directos e indirectos. En este artículo, nuestro objetivo fue analizar los efectos y los posibles mecanismos subyacentes de COVID -19, así como las posibles implicaciones de los tratamientos dirigidos contra este virus en el sistema cardiovascular.

A comparative study of serum uric acid level in various acute coronary syndromes and its short term prognostic significance using KILLIP classification

Background: Serum uric acid is increased in ischemic conditions and is significantly higher in patients with acute myocardial infarction. The aim of study was to correlate serum uric acid level with KILLIP class in respect of mortality and morbidity profile of patients with acute coronary syndromes..Methods: 100 patients fulfilling the standard diagnostic criteria for acute coronary syndromes on the basis of classical history, clinical signs, ECG changes and biomarkers were included in the study. Age and sex matched 50 normal healthy subjects were also included as control group after obtaining informed consent. Serum uric acid level was measured on day 0, 3 and 7 of various ACS.Results: There was statistically significant higher level of serum uric acid concentration in patients of AMI on day of admission as compared to controls and unstable angina patients. On all three days of serum uric acid estimation, the serum uric acid levels were higher in AMI patients who were in higher KILLIP class as compared to lower KILLIP class group. Smokers had significantly higher baseline serum uric acid but age, sex, dyslipidemia, hypertension and diabetes mellitus did not significantly affect serum uric acid level at any stage in various ACS patients. Five patients who died during hospital stay, had serum uric acid level more than 7.0 mg/dL and all of them were in KILLIP class III and IV.Conclusions: serum uric acid level is a strong and independent risk factor in predicting mortality and morbidity profile of patients of acute myocardial infarction. Also, serum uric acid level correlates well with KILLIP class.

Determination of Coronary Artery Disease and Cardiovascular Risk Factors

Coronary artery disease (CAD) is one of the most common causes of mortality and morbidity. The present study was conducted to assess the cardiovascular risk factors in patients with Coronary artery disease. Methods: The present study was conducted on 84 patients less than 40 years old of both genders. All patients were subjected to ECG. Patients presenting with serial ECG – ST segment elevation in more than 2 contiguous leads, ST segment depression > 1 mm in 2 contiguous leads and/or T-wave inversion during chest pain, episodes or any bundle branch block (new onset LBBB or RBBB) or AV block were selected. Serum biochemistry such as serum electrolytes such as serum Na+, serum K+, lipid profile and renal function tests were performed. Results: ST elevation MI was seen in 22 males and 20 females, non ST elevation MI in 14 males and 13 females and unstable angina in 6 males and 9 females. Common risk factors in CAD were smoking seen in 38, obesity in 14, sedentary lifestyle in 26, hypertension in 26, positive family history of premature IHD in 14, dyslipidemia in 45 and diabetes in 12. The difference was significant (P< 0.05). Conclusion: Acute coronary syndromes are a major cause of concern in the present-day world particularly when it happens in a younger age group population. There is association of conventional CV risk factors, such as, dyslipidemia, hypertension, sedentary lifestyle and smoking with coronary artery disease.

The clinical application of high-sensitivity cardiac troponin T in diagnosis of non-ST-segment elevation acute coronary syndrome / 中国中西医结合急救杂志

Objective To investigate the clinical application of high-sensitivity cardiac troponin T (hs-cTnT) in the diagnosis of patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods The clinical data of 126 patients with NSTE-ACS admitted to the Department of Emergency of the Third People's Hospital in Yunnan Province from July 2016 to June 2017 were retrospectively analyzed, including 76 patients in non-ST-segment elevation myocardial infarction (NSTEMI) group and 50 patients in unstable angina (UA) group. Moreover, the clinical data of venous blood hs-cTnT and creatine kinase MB (CK-MB) were collected at immediate admission, 4 hours and 12 hours after admission to the hospital in the two groups. At last, the differences in levels of hs-cTnT and CK-MB were compared between the two groups. Results The hs-cTnT and CK-MB in NSTEMI group were gradually increased with the prolongation of therapeutic time, the elevation ratios of hs-cTnT were 88.2% (67 cases) and 100.0% (76 cases), 100.0% (76 cases) at admission and 4 hours, 12 hours after admission respectively; and the elevation ratios of CK-MB were 60.0% (30 cases), 80% (40 cases) and 96% (48 cases) respectively at the above time points; there were no significant differences in UA group. The levels of hs-cTnT and CK-MB in NSTEMI group were significantly higher compared to those of UA group at admission and 4 hours, 12 hours after admission [hs-cTnT (μg/L): the levels were respectively 0.182±0.052 vs. 0.010±0.001, 2.421±0.084 vs. 0.011±0.012, 5.647±0.012 vs. 0.11±0.012, CK-MB (U/L): the levels were respectively 36.3±12.1 vs. 8.1±0.5, 179.6±26.3 vs. 8.5±0.5, 286.0±23.2 vs. 7.9±0.7, all P ＜ 0.05]. Conclusion The blood level of hs-cTnT in acute myocardial infarction (AMI) patients is obviously increased, which can be used as the basis to distinguish NSTEMI from UA.

NT-proBNP,Hcy and hs-CRP levels in patients with acute coronary syndromes and its clinical significance / 国际检验医学杂志

Objective To investigate the levels of N-terminal B-type brain natriuretic peptide (NT-proB-NP) ,homocysteine (Hcy) and high-sensitivity C reactive protein (hs-CRP) in serum of patients with acute coronary syndromes and clinical significance .Methods Twenty hundred patients with acute coronary syn-dromes were enrolled in our hospital from March 2016 to February 2017 .Fifty patients with healthy subjects were selected as control .Serum samples were collected and immunocytochemistry Serum levels of NT-proB-NP ,Hcy and hs-CRP were measured by cyclic enzyme method and immunoturbidimetric turbidimetric assay . Results The levels of NT-proBNP ,Hcy and hs-CRP in serum of patients with acute coronary syndromes were significantly higher than those of healthy subjects .The positive rate of serum test was 91 .50% .The more seri-ous the disease and the higher the number of coronary lesions The levels of NT-proBNP ,Hcy and hs-CRP in patients with acute coronary syndromes were higher .Conclusion The combination of three serum markers coronary artery syndrome in the clinical diagnosis and treatment has important reference value .

Phase angle is associated with the length of ICU stay in patients with non-ST elevation acute coronary syndrome

Background: The aim of this study was to evaluate the associations between phase angle (PhA), sarcopenia, and the length of stay (LOS) in the coronary intensive care unit (ICU) in patients with non-ST acute coronary syndrome(NSTE-ACS).Methods: This was a prospective observational study that evaluated 80 patients with NSTE-ACS over the age of18 years, admitted to the ICU from January to June 2014. Upon admission, the patients'demographic information was recorded. Handgrip strength and bioelectrical impedance analysis (BIA) were performed, and blood samples were taken within the first 72 h of admission. All of the patients were followed during their ICU stays. Results: We evaluated 80 patients, five were excluded due to impossibility of assessing handgrip strength, and seven patients were not subjected to BIA. Thus, 68 patients with a mean age of 63.3 ± 13.1 years were included in the analysis. Among these patients, 60.1% were male, 27.9% of the patients had sarcopenia, 8.8% had LOSs≥8 days, and median phase angle was 6.5 (6.1­7.3)°. Multiple logistic regression adjusted for age and gender revealed tha PhA was not associated with the presence of sarcopenia. Additionally, PhA (OR 0.337; CI 95% 0.118­0.961;p= 0.04)but not sarcopenia (OR 0.517; CI 95% 0.055­4.879;p= 0.56) was associated with an increased LOS. Conclusions: PhA is associated with LOS in patients with NSTE-ACS. Additionally, there was no association between PhA and sarcopenia.

Síndrome coronario agudo en el anciano: evaluación, diagnóstico y tratamiento / Acute coronary syndrome in the elderly: assessment, diagnosis and treatment

Introducción: la enfermedad coronaria, y en especial los síndromes coronarios agudos, son un grupo de entidades que generan alta mortalidad en la población anciana, que a su vez, representa un grupo poblacional importante en las diversas series epidemiológicas, caracterizándose por sus dificultades diagnósticas y terapéuticas, caracterizadas por una pobre cantidad de estudios y una baja representatividad en los ensayos clínicos, generando grandes dudas en la práctica clínica diaria. Objetivo: describir los aspectos más actualizados y relevantes en síndrome coronario agudo en el anciano, haciendo énfasis en el proceso diagnóstico y sus variaciones, y las consideraciones terapéuticas basadas en la última evidencia científica disponible. Metodología: se realizó una revisión sistemática de la literatura sobre síndrome coronario agudo en el anciano publicado en los últimos 20 años, desde 1996 hasta 2016, en las bases de datos PubMed, y Embase durante los meses de diciembre de 2015 y enero de 2016.Se incluyeron artículos en idioma inglés y español. La exclusión de los estudios se hizo con base a la evaluación de los resúmenes. Conclusión: los ancianos son un grupo poblacional altamente heterogéneo, presentando múltiples cambios fisiológicos carviovasculares, generando grandes variaciones en la clínica del síndrome coronario agudo. Su representación en los diferentes ensayos clínicos sigue siendo pobre, loque dificulta la toma de decisiones en la práctica clínica. Se requieren más estudios para precisar el manejo más óptimo en el anciano...(AU)

Introduction: the coronary diseases, especially the acute coronary syndromes, gather a group of entities that lead to high mortality rates among older patients, who represent a very important population in epidemiological terms, given their characteristic diagnostic and therapeutic difficulties, which can be explained by the poor amount of studies and a low representation at clinical trials, thus generating great doubts in daily clinical practice. Objective: to describe the most updated and relevant aspects in acute coronary syndrome in the old patient, emphasizing in the diagnostic process and its variations, and therapeutic considerations based on last available scientific evidence. Methodology: a systematic review of literature about acute coronary syndrome in the old patient published in last 20 years, from 1996 to 2016 was performed, in data bases Pubmed and Embase during December 2015 and January 2016. Articles in English and Spanish were included. The studies were excluded based on abstracts assessment.Conclusion: the old patients represent a very highly heterogeneous group which presents multiple physiological cardiovascular changes, generating important variations in symptomatology of acute coronary syndrome. Their representation among different clinical trials remains being poor, which turns very difficult making decisions in clinical practice. More studies are required in order to achieve the most optimal management in the old patient...(AU)

Characteristic of peripheral blood monocyte subsets and chemokines in early stage of acute coronary syndrome / 复旦学报（医学版）

Objective To investigate the expression of monocyte subsets and their chemokine,i.e.,monocyte chemoattractant protein (MCP-1) and fractalkine (FKN),in patients with acute coronary svndrome (ACS),and to analyze their correlation.Methods Patients with the syndrome of pectoralgia and to be inspected with coronary angiography (CAG) in our hospital from Sep.to Dec.,2016 were included.Patients' venous blood was collected on the operation day before operation,the level and proportion of monocyte (Mon) subsets,which was namely CD14 + CD16-Mon (Mon1),CD14+CD16 + Mon (Mon2) and CD14-CD16 + Mon (Mon3) according to the expression of cluster differentiation-14 (CD14) and CD16,were detected by flow cytometry (FCM).Patients' venous blood was collected on the operation day before operation and one day after operation,the concentrations of MCP-1 and FKN in plasma were measured by ELISA.We compared the expression levels of MCP-1-Mon1 and FKN-Mon3,and analyzed their relationship between each other respectively in different groups.Results Diagnosed according to the clinical symptoms,myocardial markers,electrocardiogram and CAG results,70 individuals were analyzed,including 30 patients with acute myocardial infarction (AMI group),25 patients with unstable angina pectoris (UAP group) and 15 patients with the chest pain symptoms and normal CAG results (control group).The percentage of Mon1 in the AMI group was higher than that in the other groups (P＜0.05);no difference was observed for Mon3 among the groups (P＞0.05).The Mon3/Mon1 ratio in the AMI group was lower than that in the control group (P＜0.05).Moreover,the levels of FKN and MCP-1 in the ACS group were greater than those in the control group.The level of red blood cell distribution width (RDW) was significantly increased in the AMI and UAP group than that in the control group (P＜0.05).There was a significant correlation between FKN and Mon3 (P＜0.05,R=0.650 2).Conclusions The monocyte subset of Mon1 and Mon3 increased in the early stage of ACS,with their chemokine (FKN and MCP-1) increasing at the same time.There is a significant correlation between FKN and Mon3,which indicates MCP-1-Mon1 and FKN-Mon3 may participate in the pathophysiological process of early ACS in patients.

Analysis of risk factors of postmyocardial infarction syndrome in female patients with acute coronary syndromes / 中国基层医药

Objective To analyze the risk factors of postmyocardial infarction syndrome(PMIS)to female patients with acute coronary syndromes(ACS).Methods 258 female patients with ACS complicated with myocardial infarction were selected, of whom 24 patients with PMIS.The clinical data of the two groups were compared and made Logistic regression analysis with different factors to get independent risk factors for PMIS.Results Of 258 female patients with ACS complicated with myocardial infarction, 24 patients with PMIS, the proportion was 9.30%.The age, infarct size, fibrinogen(FIB) level, creatine kinase isoenzymes(CK-MB) level and troponin I(cTnI) level of PMIS group were (64.95±4.95)years old,(11.65±1.52)cm, (2,6.91±1.86)g/L,(36.91±2.46)ng/L,(8.91±1.54)ng/L,respectively, which were higher than those in non-PMIS group[(56.18±4.83)years old,(8.83±1.49)cm2,(5.41±1.58)g/L,(33.88±2.25)ng/L,(6.40±1.17)ng/L](t=8.452,8.814,4.354,6.229,9.695,all P＜0.05).The proportion of patients with smoking and drinking habits, proportion of patients with underlying diseases, proportion of patients with chronic pulmonary disease, proportion of patients with heart and stalk history, proportion of patients with Killip grade Ⅲ-Ⅳ were 16.67%,37.50%,20.83%,66.67%,66.67%,respectively,which were higher than those in non-PMIS group (4.70%,11.97%,8.97%,31.20%,31.20%, x2=5.692,11.553,4.378,12.120,7.172,all P＜0.05).Logistic regression analysis showed that basic disease, history of myocardial infarction, infarct size, Killip classification, CK-MB level and cTnI level were independent risk factors for PMIS.Conclusion The combination of basic disease, history of myocardial infarction, larger infarct size, higher Killip classification, high CK-MB level and high cTnI level can increase the risk of PMIS in female patients with ACS.

Mortality reduction with use of oral beta-blockers in patients with acute coronary syndrome

OBJECTIVES: Recent studies have revealed a relationship between beta-blocker use and worse prognosis in acute coronary syndrome, mainly due to a higher incidence of cardiogenic shock. However, the relevance of this relationship in the reperfusion era is unknown. The aim of this study was to analyze the outcomes of patients with acute coronary syndrome that started oral beta-blockers within the first 24 hours of hospital admission (group I) compared to patients who did not use oral beta-blockers in this timeframe (group II). METHODS: This was an observational, retrospective and multicentric study with 2,553 patients (2,212 in group I and 341 in group II). Data regarding demographic characteristics, coronary treatment and medication use in the hospital were obtained. The primary endpoint was in-hospital all-cause mortality. The groups were compared by ANOVA and the chi-square test. Multivariate analysis was conducted by logistic regression and results were considered significant when p<0.05. RESULTS: Significant differences were observed between the groups in the use of angiotensin-converting enzyme inhibitors, enoxaparin, and statins; creatinine levels; ejection fraction; tabagism; age; and previous coronary artery bypass graft. Significant differences were also observed between the groups in mortality (2.67% vs 9.09%, OR=0.35, p=0.02) and major adverse cardiovascular events (11% vs 29.5%, OR=4.55, p=0.02). CONCLUSIONS: Patients with acute coronary syndrome who underwent early intervention with oral beta-blockers during the first 24 hours of hospital admission had a lower in-hospital death rate and experienced fewer major adverse cardiovascular events with no increase in cardiogenic shock or sustained ventricular arrhythmias compared to patients who did not receive oral beta-blockers within this timeframe.

Clinical management and hospital outcomes of acute coronary syndrome patients in Mexico: The Third National Registry of Acute Coronary Syndromes (RENASICA III) / Abordaje clínico y evolución hospitalaria en pacientes mexicanos con sindrome coronario agudo: El Tercer Registro Nacional de Síndromes Coronarios Agudos (RENASICA III)

Abstract Objective To describe current management and clinical outcomes in patients hospitalized with an acute coronary syndrome (ACS) in Mexico. Methods RENASICA III was a prospective multicenter registry of consecutive patients hospitalized with an ACS. Patients had objective evidence of ischemic heart disease; those with type II infarction or secondary ischemic were excluded. Study design conformed to current quality recommendations. Results A total of 123 investigators at 29 tertiary and 44 community hospitals enrolled 8296 patients with an ACS (4038 with non-ST-elevation myocardial infarction/unstable angina [NSTEMI/UA], 4258 with ST-elevation myocardial infarction [STEMI]). The majority were younger (62 ± 12 years) and 76.0% were male. On admission 80.5% had ischemic chest pain lasting >20 min and clinical stability. Left ventricular dysfunction was more frequent in NSTEMI/UA than in those with STEMI (30.0% vs. 10.7%, p < 0.0001). In STEMI 37.6% received thrombolysis and 15.0% primary PCI. PCI was performed in 39.6% of NSTEMI/UA (early strategy in 10.8%, urgent strategy in 3.0%). Overall hospital death rate was 6.4% (8.7% in STEMI vs. 3.9% in NSTEMI/UA, p < 0.001). The strongest independent predictors of hospital mortality were cardiogenic shock (odds ratio 22.4, 95% confidence interval 18.3-27.3) and ventricular fibrillation (odds ratio 12.5, 95% confidence interval 9.3-16.7). Conclusion The results from RENASICA III establish the urgent need to develop large-scale regional programs to improve adherence to guideline recommendations in ACS, including rates of pharmacological thrombolysis and increasing the ratio of PCI to thrombolysis.

Resumen Objetivo Describir abordaje terapéutico actual y evolución en pacientes hospitalizados con un síndrome coronario agudo (SCA) en México. Métodos RENASICA III registro multicéntrico prospectivo de pacientes consecutivos con un SCA. Todos tuvieron demostración objetiva de enfermedad coronaria; se excluyeron infarto tipo II o isquemia secundaria. El diseño incluyó recomendaciones actuales de calidad. Resultados 123 investigadores en 29 hospitales de tercer nivel y en 44 de segundo ingresaron 8296 pacientes, 4038 con infarto del miocardio sin elevación del ST/angina inestable (IMSEST/AI) y 4258 con infarto del miocardio y elevación del ST (IMEST). La mayoría fueron jóvenes (62 ± 12 años) y el 76% del sexo masculino. Al ingreso 80.5% tuvo dolor torácico con perfil isquémico >20 minutos y estabilidad clínica. Se observó mayor disfunción ventricular en grupo con IMSEST/AI que en aquellos con IMEST (30.0% vs 10.7%, p <0.0001). En IMEST el 37.6% recibió trombolisis y el 15% angioplastía primaria. Este procedimiento se realizó en el 39.6% de los pacientes con IMSEST/AI (estrategia temprana 10.8%, estrategia urgente 3.0%). La mortalidad hospitalaria fue del 6.4% (8.7% IMEST vs. 3.9% IMSEST/AI, p <0.001). Los predictores independientes con mayor poder para mortalidad fueron choque cardiogénico (RM 22.4, 95% IC 18.3-27.3) y fibrilación ventricular (RM 12.5, 95% IC 9.3-16.7). Conclusión los resultados del RENASICA III establecen la urgente necesidad de desarrollar en SCA programas regionales a gran escala para mejorar el apego a la guías y recomendaciones, incluyendo mayor porcentaje de trombolisis e incrementar la proporción de angioplastia primaria.

Immune hyper-activation of multiple lymphocyte subsets in acute coronary syn-drome / 中国免疫学杂志

Objective:The process of myocardial infarction is generally characterized by the activation of host immune cells and the occurrence of inflammation. However, it is unknown which immune cells are preferentially activated and participated into the progression of myocardial infarction. Methods:A total of 55 patients with myocardial ischemia including 13 of stable angina ( SA) ,25 of unstable angina (UA) and 17 of acute myocardial infarction (AMI) as well as 12 of healthy controls (HCs) were enrolled in the study. The frequency and the immune activation marker CD38 expression by peripheral CD3 T cells,CD4 T cells,CD8 T cells,CD4+NKT cells, CD4- NKT cells, CD3-CD56+ NK cells and B cells were comprehensively analyzed. Results:There was no significant difference in the frequencies of these immune cell subsets in peripheral blood among these four groups. Importantly,it was found that CD38 expression was significantly increased on CD8 T cells,NKT cells and NK cells in patients with acute coronary syndromes ( ACS) including UA and AMI patients as compared with those in SA and HC subjects. These data indicated that multiple immune cells were activated in ACS patients,which were possibly participated into the pathogenesis of ACS. Conclusion:The activation of multiple immune cells was closely associated with the progression and outcome in ACS patients. This study provides immune hyper-activation mechanism underlying the development of ACS and may favor for finding a novel immune marker to predict the progression of ACS.

Current Status and Clinical Effectiveness of Anticoagulant Therapy for In-hospital Patients With Acute Coronary Syndromes at County Hospitals of China / 中国循环杂志

Objective: To analyze the current status of anticoagulant therapy for in-hospital patients with acute coronary syndromes (ACS) at county hospitals of China and to explore the relationship between anticoagulant therapy and clinical outcomes in real medical environment. Methods: 99 county hospitals from15 provinces of China were selected for this prospective registry study and 12373 eligible ACS patients without interventional therapy admitted from 2011-09 to 2014-06 were enrolled. The basic condition, previous history, initial assessment, anticoagulants (unfractionated heparin/low molecular weight heparin) application, severe bleeding events and in-hospital mortality were collected in all patients. Multiple logistic regression analysis was conducted to explore the relationship between anticoagulant therapy and clinical outcomes including in-hospital mortality, severe bleeding events and combined endpoints; meanwhile, possible confounders were adjusted. Results: A total of 9985/12373 ACS patients received anticoagulant therapy and 2388 did not. Anticoagulant therapy was conducted in 92.7% (4237/4570) patients with ST-segment elevation myocardial infarction (STEMI), 90.8% (1639/1805) with non-ST-segment elevation myocardial infarction (NSTEMI) and 68.5% (4109/5998) with unstable angina (UA); there were differences by regions and genders,P0.05. Meanwhile, it did not increase the risk of severe bleeding events in ACS patients,P>0.05. Conclusion: Anticoagulant therapy has been widely used in STEMI and NSTEMI patients at county hospitals of China and obviously decreased the in-hospital mortality; while the application rate was relatively low in UA patients. The general safety of anticoagulant therapy has been good in ACS patients.