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Objective:To investigate the clinical application value of left ventricular myocardial strain obtained by cardiac MR (CMR) in recent major adverse cardiovascular events (MACE) in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).Methods:From January 2020 to December 2020, a total of 163 patients successfully underwent primary PCI and underwent CMR examination within one week after surgery at Affiliated Hospital of Xuzhou Medical University. The scan sequences included rapid balance-fast field echo and late-gadolinium enhancement. CVI42 post-processing software was used to analyze and measure the left ventricular myocardial strain indices, including left ventricular global longitudinal strain (GLS), left ventricular global circumferential strain (GCS), and left ventricular global radial strain (GRS). According to the results of the 1-year follow-up after surgery, the patients were divided into the MACE group ( n=28) and the non-MACE group ( n=135). For continuous variables with a normal distribution, the t test of two independent samples was used for comparisons between groups. For continuous variables with an abnormal distribution, the variables were compared and analyzed by the rank sum test. For categorical variables, the χ 2 tests were used for between-group comparisons. Cox regression was used to analyze the prognostic value of myocardial strain on the development of MACE in patients with STEMI. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic efficacy of myocardial strain parameters, and the optimal cut-off value was evaluated by calculating the Youden index. Results:The GLS, GCS, and GRS of the MACE group were (-10.4±3.3)%, [-11.9 (-14.5, -9.3)]%, and (18.3±6.3)%, respectively, and those of the non-MACE group were (-13.7±3.4)%, [-14.6 (-16.4, -11.7)]%, and (22.3±6.1)%, respectively. The difference between the two groups was statistically significant ( t/ Z=-4.71, -3.04, 3.21, P<0.05). Multivariate Cox regression analysis showed that GLS was an independent predictor of MACE (HR=1.546, 95%CI 1.180-2.027, P=0.002). The ROC curve analysis showed that GLS had the largest area under the curve (AUC) (AUC=0.754, 95%CI 0.658-0.851, P<0.001), with a cut-off value of -12.45%. Its diagnostic sensitivity was 71.4%, and the specificity was 67.4%. The value was better than that of the traditional predictor of STEMI prognosis, namely, left ventricular ejection fraction (AUC=0.680, 95%CI 0.567-0.793, P=0.003). Conclusion:GLS of CMR is an independent predictor of MACE in STEMI patients undergoing primary PCI.
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Objective:To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI.Results:In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade Ⅲ, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95% CI) was 0.702-0.923], 0.725 (95% CI was 0.666-0.812) and 0.882 (95% CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. Conclusions:The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.
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@#Objective To explore the predictive value of a simple prediction model for patients with acute myocardial infarction. Methods Clinical data of 280 patients with acute ST-segment elevation myocardial infarction (STEMI) in the Department of Emergence Medicine, West China Hospital of Sichuan University from January 2019 to January 2020 were retrospectively analyzed. The patients were divided into a death group (n=34) and a survival group (n=246). Results Age, heart rate, body mass index (BMI), global registry of acute coronary events (GRACE), thrombolysis in myocardial infarction trial (TIMI) score, blood urea nitrogen, serum cystatin C and D-dimer in the survival group were less or lower than those in the death group (P<0.05). Left ventricle ejection fraction and the level of albumin, triglyceride, total cholesterol and low density lipoprotein cholesterol were higher and the incidence of Killip class≥Ⅲ was lower in the survival group compared to the death group (P<0.05). Multivariate logistic regression analysis showed that age, BMI, heart rate, diastolic blood pressure, and systolic blood pressure were independent risk factors for all-cause death in STEMI patients. Receiver operating characteristic (ROC) curve analysis showed that the area under the curve of simple prediction model for predicting death was 0.802, and similar to that of GRACE (0.816). The H-L test showed that the simple model had high accuracy in predicting death (χ2=3.77, P=0.877). Pearson correlation analysis showed that the simple prediction model was significantly correlated with the GRACE (r=0.651, P<0.001) and coronary artery stenosis score (r=0.210, P=0.001). Conclusion The simple prediction model may be used to predict the hospitalization and long-term outcomes of STEMI patients, which is helpful to stratify high risk patients and to guide treatment.
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Background:@#The mortality of cardiovascular disease is constantly rising, and novel biomarkers help us predict residual risk. This study aimed to evaluate the predictive value of serum homocysteine (HCY) levels on prognosis in patients with ST-segment elevation myocardial infarction (STEMI).@*Methods:@#The 419 consecutive patients with STEMI, treated at one medical center, from March 2010 to December 2015 were retrospectively investigated. Peripheral blood samples were obtained within 24 h of admission and HCY concentrations were measured using an enzymatic cycling assay. The patients were divided into high HCY level (H-HCY) and low HCY level (L-HCY) groups. Short- and long-term outcomes were compared, as were age-based subgroups (patients aged 60 years and younger vs. those older than 60 years). Statistical analyses were mainly conducted by Student t-test, Chi-squared test, logistic regression, and Cox proportional-hazards regression.@*Results:@#The H-HCY group had more males (84.6% vs. 75.4%, P=0.018), and a lower prevalence of diabetes (20.2% vs. 35.5%, P < 0.001), compared with the L-HCY group. During hospitalization, there were seven mortalities in the L-HCY group and 10 in the H-HCY group (3.3% vs. 4.8%, P= 0.440). During the median follow-up period of 35.8 (26.9–46.1) months, 33 (16.2%) patients in the L-HCY group and 48 (24.2%) in the H-HCY group experienced major adverse cardiovascular and cerebrovascular events (MACCE) (P=0.120). History of hypertension (hazard ratio [HR]: 1.881, 95% confidence interval [CI]: 1.178–3.005, P=0.008) and higher Killip class (HR: 1.923, 95% CI: 1.419–2.607, P < 0.001), but not HCY levels (HR: 1.007, 95% CI: 0.987–1.027, P=0.507), were significantly associated with long-term outcomes. However, the subgroup analysis indicated that in older patients, HCY levels were significantly associated with long-term outcomes (HR: 1.036, 95% CI: 1.011–1.062, P=0.005).@*Conclusion:@#Serum HCY levels did not independently predict in-hospital or long-term outcomes in patients with STEMI; however, among elderly patients with STEMI, this study revealed a risk profile for late outcomes that incorporated HCY level.
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Objective To assess the impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction (STEMI) and type 2 diabetes.Methods Three hundred and three patients with type 2 diabetes and first STEMI between May 2014 and December 2016 in Beijing Anzhen Hospital,Capital Medical University were seclected continuously.All participants' continuous glucose monitoring system (CGMS) parameters,echocardiogram and biochemical characteristics were measured at baseline.According to the level of mean amplitude of glycemic excursion (MAGE) which is the gold indicator to present glycemic variability patients were classified into low MAGE group (n=182) and high MAGE group (n =117).Impact of glycemic variability on left ventricular function in patients with acute ST-segment elevation myocardial infarction and type 2 diabetes were analysed.Results (1) Cardiac function evaluation:The level of left ventricular ejection fraction (LVEF) were significantly lower in high MAGE group than in low MAGE group ((43.8± 7.2) vs.(52.3± 8.5) ％,t =4.912,P＜ 0.001).There were significant differences between the two groups in Killip classification (x2 =49.931,P＜ 0.001).(2) Pearson correlation analysis shows that LVEF negatively correlated with the levels of MAGE(r=-0.367,P＜0.001),postprandial glucose excursion (PPGE) (r=-0.274,P=0.003),Hemoglobin A1c(HbA1c) (r=-0.238,P =0.010),serum highsensitive C-reactive protein (hs-CRP) via logarithmic transformation (r =-0.245,P =0.008) and fasting plasma glucose (FPG) (r =-0.229,P =0.021).Killip classification positively correlated with the levels of MAGE (r =0.301,P ＜ 0.001),PPGE (r =0.228,P =0.022),hs-CRP via logarithmic transformation (r =0.234,P =0.019),H bA 1 c (r =0.195,P =0.041) and FPG (r =0.193,P =0.045).(3) Multiple stepwise regression analysis and multivariate Logistic regression analysis indicated that the level of MAGE was independent risk factor of LVEF (t =-2.279,P =0.005,95％ CI(-3.160 -0.219)) and the level of MAGE was an independent risk factor of Killip classification (Waldx2 =5.673,OR=1.665,95％CI(1.095-2.534),P=0.017).Conclusion Glycemic variability is associated with the presence and severity of left ventricular function in patients with STEMI and type 2 diabetes.
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Objective To explore the related factors affecting the formation of different types of thrombosis in patients with STEMI. Methods Retrospective data were collected from September 2014 to October 2018 in Henan Province People's Hospital for emergency interventional treatment of patients with STEMI. According to the type of thrombus detected by OCT, they were divided into two groups, which were red thrombus group and white thrombus group. Clinical baseline data, coronary angiographic findings, and OCT results were collected in patients with STEMI. Logistic regression analysis was used to analyze the type of thrombosis in patients with STEMI. Results The rate of thrombus detection was 100％ in 92 patients with STEMI. According to OCT diagnostic criteria, 73 (79.3％) patients were classified into red thrombus and 19 (20.7％) were white thrombus. There was no significant difference in infarct-related artery and location between the two groups (P>0.05) , but there was more multiple vascular lesions in the white thrombus group than that in the red thrombus group. There was significant difference in the incidence of plaque rupture and thin fibrous cap in the two groups (P<0.05). The incidence of plaque rupture and thin fibrous cap lipid plaque was higher in the red thrombus group. Plaque rupture (OR = 2.894, 95％CI:2.704-2.956) , thin fibrous cap plaque (OR = 8.033, 95％CI: 7.985-8.283) , single vessel disease (OR = 1.746, 95％ CI: 1.659-1.785) are risk factors for red thrombosis formation. Conclusion Single vessel lesion, plaque rupture andthin fibrous cap lipid plaque are associated with red thrombus formation.While, multiple vessel lesions and stable plaque are associated with white thrombus formation.
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ObjectiveTo compare the treatment of acute ST-elevated myocardial infarction (STEMI) before and after the certification of chest pain center model, so as to provide reference for the construction of chest pain center. Methods We retrospectively analyzed the clinical data of patients with acute STEMI before and after certification of the chest pain center of Shanghai General Hospital of Shanghai Jiao Tong University. Totally 119 patients were included in the pre-certification group from January 2017 to December 2017, and 160 patients were included in the post-certification group from January 2018 to April 2019. The baseline data, first medical contact to electrocardiogram (ECG) time, first ECG confirmation time, troponin reporting time, cath lab activation time, door-to-balloon dilation time, hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, and outcomes were compared between the two groups. Results There was no significant difference in the gender, age, history of hypertension or history of diabetes between the two groups (all P>0.05). The cath lab activation time was not significantly different between the two groups (P>0.05). The first medical contact to ECG time (Z?-7.247, P0.05). Conclusion Through the certification and standardized operation of chest pain center, the time of treatment for acute STEMI can be significantly shortened.
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Objective To explore the risk factors of contrast-induced nephropathy (CIN) in patients with acute ST-segment elevation myocardial infarction(STEMI)treated with emergent percutaneous coronary intervention(PCI).Methods The clinical data of patients with STEMI treated by emergent PCI from January 2014 to February 2017 in Peking University People's Hospital was reviewed.Exclusion criteria included contrast agent allergy,previous renal diseases,chronic renal failure,heart failure,tumor,acute infection,only one renal function test available during hospitalization and lacking essential medical records.Data of demographics,past medical history,general conditions at admission,laboratory findings,etc,were collected.Patients were divided into CIN group and non-CIN group.The univariate comparison analysis and Logistic regression analysis were performed to obtain the risk factors of CIN.Results A total of 236 patients were enrolled.The incidence of CIN was 10.2％ (24/236).Univariable analysis demonstrated that the risk factors of CIN were age,diabetes mellitus,Killip grade ≥ 3 stage,serum uric acid (SUA) level at admission,blood glucose level at admission.Binary logistic regression analysis showed that SUA ≥ 350 μ mol/L at admission,blood glucos ≥ 11 mmol/L at admission,age ≥ 75 years were independent risk factors for CIN.Conclusion SUA ≥ 350 μ mol/L at admission,blood sugar ≥ 1 1 mmol/L at admission,age ≥ 75 years were independent risk factors of CIN in patients with STEMI treated with emergent PCI.
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Objective To explore the clinical feasibility and safety of early intervention for severe stenosis of non-infarct related artery(non-IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI) and multi-vessel disease(MVD)after successful primary percutaneous coronary intervention(PCI)for infarct-asso-ciated artery(IRA). Methods From May 1st,2011 to December 30th,2016,165 patients with STEMI and MVD were enrolled in our study. After the completion of primary PCI in IRA ,75 patients still in the hospital agreed to undergo a second staged PCI in severe stenosis of non-infarct arteries. We analyzed the in-hospital adverse events ,the length of hospital stay and clinical outcomes during the follow-up in the study population. Results There was no significant difference in the incidence of adverse events between the two groups during hos-pitalization. However,compared to patients treated with the IRA-only PCI,those treated with early intervention for severe stenosis of non-IRA was associated with greater benefits for clinical outcomes(including rehospitalization for heart failure,rehospitalization for ACS,recurrent angina pectoris,necessity for reintervention)during the follow-up except for the all-cause mortality. Conclusion Early intervention for severe stenosis of non-IRA is a feasible and safe procedure in patients with acute STEMI and MVD after successful primary PCI.
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Objective This study investigated the relation with the location of infarction and brain natriuretic peptide (BNP),left ventricular ejection fraction (LVEF) for first acute ST-segment elevation myocardial infarction.Methods From January 2014 to December 2016,163 consecutive patients with ASTEMI who admitted to our hospital were enrolled in this study,were divided by infarction position.All the patients were classified into wide anterior infarction group,anterior infarction group,anterior septal infarction group and inferior infarction group.The BNP level and the LVEF were measured for 163 consecutive patients respectively on admission and after six-month follow-up visit and record the adverse cardiovascular events,comparing their relations.Results The BNP level of wide anterior infarction group were all significantly higher than all the other groups on admission and after six-month follow-up visit,but the LVEF were significantly lower than all the other groups (P ＜ 0.05).The BNP level of anterior infarction group were significantly higher than anterior septal infarction group and inferior infarction group on admission and after six-month follow-up visit,but the LVEF were significantly lower than anterior septal infarction group and inferior infarction group (P ＜ 0.05).The BNP level of anterior septal infarction group were higher than inferior infarction group on admission and after six-month follow-up visit,but the LVEF were lower than inferior infarction group (P ＜ 0.05).Meanwhile,the incidence of adverse cardiovascular events of the wide anterior infarction group,anterior infarction group,anterior septal infarction group were all larger than inferior infarction group,and the wide anterior infarction group was the largest.Conclusion There is a close relationship with infarction position,BNP and LVEF.The location of infarction,BNP level and LVEF counld all be recognized as the important predicted indicator of adverse cardiovascular events,premature complication and prognosis.
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Objective To investigate the effect of optimizing rescue time for patients with acute st-elevation myocardial infarction (STEMI) in the hospital. Methods A retrospective analysis of the clinical data of 133 patients with ST-elevation myocardial infarction who were hospitalized in the first affiliated hospital of university of science and technology of china during July,2016 to June,2017 was performed. Timeline in the rescue, the result of coronary reperfusion and satisfaction degree of patients were analyzed. Results The rapid evaluation time (F=2.609, P=0.046),emergency handling time(F=7.581, P=0.032), login and logout time (F=5.667, P=0.017)and visit-ballon time (F=8.942, P=0.007) were shortened quarter by quarter . The average time of each project in the four quarters showed a statistically significant difference. The difference of TIMI classification of coronary flow reperfusion among the four quarters was statistically significant (H=8.402, P=0.038). The satisfaction degree of each quarter showed a statistically significant difference (the third quarter of 2016:94.68±2.38, the fourth quarter of 2016:96.72± 5.10, the first quarter of 2017:97.23 ± 7.64,the second quarter of 2017:98.36 ± 4.86;F=7.891,P=0.048). Conclusions Enhancing timeliness of emergency care can remarkably shorten rescue time, improve satisfaction degree of patients and help to improve the success rate of emergency treatment for patients with STEMI.
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ST-segment elevation myocardial infarction (STEMI) is the most serious type of coronary heart disease, accounting for 25%to 40%of acute myocardial infarction (AMI). The key to treat STEMI is to restore myocardial perfusion in the infarct area, to rescue the ischemic myocardium, and to reduce the size of infarction. About 41%to 67%of patients with STEMI have multiple vascular disease (MVD). Compared with single vessel disease, the clinical outcome of MVD is worse. In these patients, it still remains a controversial topic in emergency interventions for STEMI patients, the infarct-related artery only revascularization or multi-vessel revascularization, and the timing of revascularization. The clinical studies of revascularization strategy for MVD in STEMI patients have been ongoing, and the results have also led to the continuous updating of guidelines and treatment strategies.
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Recently, early reperfusion therapy has become the optimal treatment for acute ST-segment elevation myocardial infarction (STEMI). One of the most effective reperfusion strategies is percutaneous coronary intervention (PCI). Depend on the time of chest pain onset, transfer mode of patients and treatment capacity of hospital, the methods of PCI are different, including primary PCI, rescue PCI and facilitated PCI. How to seize the optimal time of intervention therapy and reduce the time interval from symptom onset to reperfusion to rescue the dying myocardial cells are the key for improving prognosis, reducing mortality and decreasing major adverse cardiovascular events (MACE) of patients.
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Objective To research the effect and safety of Reteplase for Injection combined with reduced glutathione in the treatment of acute ST segment elevation myocardial infarction.Methods Patients with acute ST segment elevation myocardial infarction (90 cases) in Jianli People's Hospital from February 2015 to February 2016 were selected and divided equally into A,B and C groups according to different treatment methods.Totally 30 patients in group A were given conventional therapy,30 patients in group B were given reduced glutathione for treatment on the basis of conventional treatment,and the other 30 in group C were given combined therapy of reteplase and reduced glutathione on the basis of conventional treatment.The vascular recanalization rate,improvement of effective indicators including creatine kinase isoenzyme (CKMB),troponin Ⅰ (cTnⅠ),left ventricular end diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF),oxidative stress kinase including superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px),and incidence of adverse events of patients were compared among the three groups.Results After thrombolysis,the vascular recanalization rate of group C at different time points (2 h,6 h and 12 h) showed significant difference compared with those of groups A and B (P ＜ 0.05).After the treatment,the effective indicators of the three groups were both significantly improved (P ＜ 0.05),and group C improved more significantly than groups A and B (P ＜ 0.05).After the treatment,the SOD and GSH-Px of groups B and C both significantly improved than group A (P ＜ 0.05),but there was no significant difference between groups B and C.After treatment,the incidence of adverse events of group C was significantly lower than those of groups A and B (P ＜ 0.05).Conclusion Reteplase for Injection combined with reduced glutathione has significant curative effect in the treatment of acute ST segment elevation myocardial infarction,which can effectively improve the cardiac function and inhibition of oxidative stress.It is of higher security but with lower incidence of adverse events.
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Objective To observe the efficacy of antithrombotic treatment of acute ST-segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden,and its effect on elective percutaneous coronary intervention.Methods Eight acute ST-segment elevation myocardial infarction patients were enrolled,who suffered from failure of primary percutaneous coronary intervention because of high thrombus burden.Summarize the antithrombotic strategies in perioperative and postoperative period,the operative strategies and the follow-up coronary intervention were recorded and reviewed.Results All the patients were male and most of them had acute inferior myocardial infarction with right coronary occluded because of high thrombus burden.Four patients received thrombus aspiration and balloon dilation.One patient received thrombus aspiration and the other three patients did not receive coronary intervention.Tirofiban were given in perioperative period to all the patients.Low molecular weight heparin was given to 6 patients.Dual antiplatelet therapy was given to 6 patients (aspirin 100 mg/day plus clopidogrel 75 mg/day) and 1 patient required up-titration of aspirin to 200 mg/day.Coronary angiography were repeated (29.00 ± 23.25) days later,and the thrombus in the culprit vessels disappeared in two patients,and coronary stent implantation was performed in three patients.Conclusions The routine antithrombotic strategies play limited roles in thrombus clearance in acute ST segment elevation myocardial infarction patients with failure primary percutaneous coronary intervention because of high thrombus burden.The time for the thrombus to be totally organized and the timing of elective percutaneous coronary intervention are still uncertain and need to be further studied.
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Objective To explore the short-term prognosis of tirofiban hydrochloride on the patients with acute ST-segment elevation myocardial infarction and the influence of tirofiban hydrochloride on myocardial biomarkers. Methods 334 patients with acute ST-segment elevation myocardial infarction were choosen. They were divided into two groups, 167 cases in each group. Tirofiban hydrochloride was used in the experimental group, and conventional therapy was carried out for control group. Compared the biochemical indexes, myocardial biomarkers and cardiac function of the two groups. Results The effective rate of experimental group was 165 cases (98.80%), which was higher than 150 cases (89.82%) in the control group (χ2=12.556,P<0.05). After treatment, the cardiac troponin I (cTnI) in experimental group was lower than control group (P<0.05). The levels of left ventricular end diastolic volume (LVEDV) and left ventricular endsystolic volume (LVESV) significantly decreased and the level of left ventricular ejection fraction (LVEF) increased in experimental group compared with those in control group(P<0.05).The global registry of acute coronary events (GRACE) after treatment in experimental group was lower than that in control group (P<0.05). The hyporrhea of thrombolysis in myocardial infarction (TIMI) in experimental group were 5 cases (2.99%), which was lower than 19 cases (11.38%) in control group (χ2=8.799,P<0.05). After 12 months, the attack frequency of angina in experimental group was (1.78±0.78)times, which was lower than (2.56±1.04) times in control group (P<0.05). Conclusion Patients with acute ST-segment elevation myocardial infarction should be diagnosed as soon as possible and take treatment strategies according to individual situation to chose suitable dosage of tirofiban hydrochloride for good therapeutic effect.
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OBJECTIVE:To explore the effects of Xuesaitong injection on related indexes of patients with acute ST segment el-evation myocardial infarction(STEMI)before percutaneous coronary intervention(PCI). METHODS:112 STEMI patients under-went PCI were analyzed retrospectively and divided into control group (48 cases) and observation group (64 cases) according to different treatment methods. Control group was given Clopidogrel sulfate tablets 300 mg and Aspirin enteric-coated tablets 300 mg orally before PCI;given conventional treatment according to patients'condition after surgery. Observation group additionally re-ceived intravenous push of Xuesaitong injection 8 mL before surgery,and Xuesaitong injection 8 mL added into Sodium chloride 250 mL intravenously,once a day after surgery,on the basis of control group. Treatment course of 2 groups lasted for 14 d. TIMI level,MPG level,the serum levels of cTnT,CKMB were observed in 2 groups before surgery,24 h after surgery;serum level of PTX-3,hs-CRP were observed before surgery,one week after surgery;LVEF,LVEDD,serum level of BNP were observed before surgery and one month after surgery;the occurrence of ADR was observed to. RESULTS:Before surgery,there was no statistical significance in TIMI level,MPG level,the serum levels of cTnT,CKMB,PTX-3 and hs-CRP,LVEF,LVEDD,serum level of BNP between 2 groups (P>0.05). 24 h after surgery,TIMI level and MPG level of 2 groups were significantly higher than be-fore,and the observation group was significantly higher than the control group;the serum levels of cTnT and CKMB in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical sig-nificance(P0.05). CONCLUSIONS:Based on convention-al treatment,Xuesaitong injection can effectively improve myocardial blood supply before PCI,decrease the level of inflammatory factor,relieve myocardial injury,improve cardiac function without increasing the incidence of ADR.
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Objective To explore the clinical characteristics of reperfusion arrhythmias (RA) in patients with ST segment el‐evation myocardial infarction(STEMI) after percutaneous coronary intervention (PCI) .Methods A total of 148 STEMI patients undergoing emergency PCI in our hospital from January 2010 to December 2014 were selected and divided into the RA group (71 cases) and non‐RA group (NRA group ,77 cases) according to whether RA occurring during PCI .The RA situation was observed . The relation between the infarct related artery and RA was analyzed ,the fall back situation of elevated ST segment was observed , the levels of cardiac troponin I (TnI) and creatine kinase isoenzyme MB (CK‐MB) and echocardiographic findings were compared between the two groups .Results The incidence rate of bradyarrhythmias in the left anterior descending coronary artery was signifi‐cantly lower than that in the right coronary artery and left circumflex artery ,while tachyarrhythmias in the left anterior descending coronary artery was higher than that in right coronary artery and left circumflex artery ,the differences were statistically significant (P<0 .05) .The opening time window and CK‐MB peak reaching time in the RA group were earlier than those in the NRA group , the fall amplitude of ST segment ,highest TnI and highest CK‐MB level in the RA group were higher tha those in the NRA group , the differences were statistically significant (P< 0 .05);among 48 cases of tachyarrhythmias ,tachyarrhythmia in 17 cases disap‐peared after intravenous drip or injection of lidocaine and which in 31 cases spontaneously disappeared without treatment ;among 23 cases of bradyarrhythmia ,bradyarrhythmia in 16 cases was controlled by intravenous injection of atropine ,which in 3 cases was con‐trolled within 1 week after placing temporary pacemaker and which in 4 cases was spontaneously disappeared without treatment . The incidence rate of main adverse events in the RA group was 2 .8% ,which was lower than 11 .7% in the NRA group ,the left ventricular ejection fraction in the RA group was significantly higher than that in the NRA group ,the end diastolic diameter and end systolic diameter of the left ventricle were significantly lower than those in the NRA group ,and the differences were statistically significant (P<0 .05) .Conclusion The incidence of RA in the patients with STEMI is higher ,which needs to adopt various effec‐tive methods to actively treat .
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Objective To establish a bedside available risk scoring system of no-reflow in the acute stage of STEMI.Methods Data from STEMI patients treated with PCI divided into model group and validation group were analyzed.Multivariable binary logistic regression analysis was used to identify independent no-reflow predictors of the model group.Finally,a score according to the odds ratio on logistic regression analysis was designed,and then risk stratification was established,and no-reflow high-risk patients with myocardial infarction were selected.The authenticity and reliability of the logistic regression courses were validated using receiver operator characteristic curve (ROC)and Hosmer-Lemeshow goodness-of-fit.Results Multivariate logistic regression analysis demonstrated that female (OR =0.587,P =0.019),Killip class of myocardial infarction≥2 (OR =3.656,P 5 was arranged into high risk level.The risk score system demonstrated a good risk prediction in the validation group with AUC of 0.891 (95%CI:0.822 -0.959)based on ROC analysis.ROC analysis in the validation group was applied to Killip class,thrombus burden,score and risk stratification in the validation group ,and the no-reflow score was more accurate,with a larger area under the curve (AUC = 0.851,95% CI:0.776 -0.927 ).Conclusions Establishment of no-reflow scoring system with STEMI patients undergoing PCI was benefit to select high risk patients with no-reflow.
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Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction (STEMI) patients after emergency percutaneous coronary intervention (PCI).Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group (standard group,n =60),and 40 mg of atorvastatin treatment group (intensive group,n =60).The blood C reactive protein (CRP),blood lipid profiles,plasma endothelin (ET) were measured before atorvastatin treatment and after 7 days of treatment,respectively.The platelet fibrin clot strength induced by ADP (MAADP) was determined by thrombelastography (TEG).Results Seven days after of atorvastatin treatment,the level of plasma ET in intensive group was significantly lower than that in standard group [(0.49 ± 0.21) pmol/L vs (0.63 ± 0.58) pmol/L,P ＜ 0.05].Moreover,the MAADP in intensive group was significantly decreased compared with the standard group [(38.4 ± 17.4) mm vs (45.7 ± 14.5) mm,P ＜ 0.05].There was a positive correlation between the ET level and MAADP in intensive group after treatment (r =0.378,P ＜ 0.05).However,no significantly differences could be viewed in the CRP and LDL-C levels between the two groups (P ＞ 0.05).Conclusion In patients with acute STEMI,early administration of 40 mg atorvastatin after emergency PCI could significantly reduce the vascular endothelial injury,improve endothelial function,and reduce the residual platelet activity.