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Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.
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Objective To evaluate the clinical value of thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) score systems in predicting the risk of in-hospital events in Chinese patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods Patients with NSTEMI admitted to the Department of Cardiovasology, Renji Hospital, Shanghai Jiao Tong University School of Medicine between Jan. 1 to Dec. 1, 2017 were consecutively enrolled. The end-point events were in-hospital mortality, reinfarction, heart failure, cardiac skock, and sudden cardiac arrest. Patients were scored by TIMI and GRACE score systems on hospital admission, and receiver operating characteristic (ROC) curve was used to evaluate the value of the two score systems and the combination of both in predicting in-hospital events. TIMI score was used to screen all the patients, and the TIMI medium-risk patients were further divided into GRACE high-risk subgroup (GRACE score≥140) and GRACE non-high-risk subgroup (GRACE score<140). The incidence of in-hospital events was compared between the two subgroups. Results A total of 232 patients were included in this study (163 males and 69 females, with an average age 66.1 years and 95% confidence interval [CI] 64.6-67.6 years). TIMI score grouped 69 (29.7%), 142 (61.2%) and 21 (9.1%) patients into low-, medium- and high-risk, and the incidence rates of in-hospital events were 14.5% (10/69), 24.6% (35/142) and 33.3% (7/21), respectively. GRACE score grouped 41 (17.7%), 85 (36.6%) and 106 (45.7%) paitents into low-, medium- and high-risk, and the incidence rates of in-hospital events were 7.3% (3/41), 11.8% (10/85) and 36.8% (39/106), respectively. GRACE score and TIMI score both demonstrated good discrimination and GRACE performed better for in-hospital events (area under curve [AUC] 0.81 vs 0.62, P<0.001). Further subgrouping the TIMI medium-risk group, we found that GRACE high-risk subgroup had significantly higher incidence rate of in-hospital events than the GRACE non-high-risk subgroup (38.2% [29/76] vs 9.1% [6/66], odds ratio 6.2, 95% CI 2.4-16.1, P<0.001). Combination of TIMI and GRACE scores improved the predictive value of in-hospital events (AUC=0.71, 95% CI 0.65-0.77), with a favorable higher positive predictive value than that of TIMI or GRACE score alone (37.1% vs 33.3% and 36.8%). Conclusion GRACE score has better predictive accuracy than TIMI score in Chinese NSTEMI patients, but sacrifices simplicity. The combination of GRACE and TIMI scores is an easy and effective discriminative tool in predicting in-hospital events in Chinese NSTEMI patients.
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Objective:To analyze the syndrome characteristics and distribution regularity of patients with non-ST segment elevation myocardial infarction (NSTEMI), in order to guide clinical practice and improve the efficacy of traditional Chinese medicine. Method:Inpatients with non-ST segment elevation myocardial infarction in line with the diagnostic criteria were selected, and the frequency statistics method was used to analyze the syndrome elements and their frequency degree and distribution characteristics. Result:According to the analysis of syndrome elements and their frequency degree of 263 patients with NSTEMI, the pathogenesis of NSTEMI was mostly deficiency in origin and excess in superficiality. As for deficiency in origin, Qi deficiency (171 times, 32.39%) was the most common, which was followed by Yin deficiency (42 times, 7.95%), Yang deficiency (16 times, 3.03%), and blood deficiency (1 times, 0.19%). As for excess in superficiality, blood stasis (129 frequency, 24.4%) and phlegm turbidity (125 frequency, 23.7%) were the most common, which were followed by heat accumulation (42 frequency, 7.95%), water drinking (2 frequency, 0.38%). According to the syndrome diagnosis analysis of the combination of syndrome elements, 220 cases (83.65%) had single syndrome differentiation, 42 cases (15.97%) had two syndromes at the same time, and 1 case (0.38%) had three syndromes at the same time. Among all the syndrome types, Qi deficiency and blood stasis syndrome (94 cases, 42.7%) was the most common, which were followed by phlegm and blood stasis syndrome (46 cases, 20.9%), Qi and Yin deficiency syndrome (41 cases, 18.6%) and heart and kidney deficiency syndrome (32 cases, 14.6%). And Yang deficiency and water flooding syndrome (6 cases, 2.73%) and heart fire blazing syndrome (1 case, 0.45%) were relatively rare. According to the distribution regularity of syndrome, traditional Chinese medicine therapies were mainly for tonifying vital qi and protecting kidney Qi, with equal emphasis on removing phlegm, eliminating dampness and diuresis, activating blood circulation and removing blood stasis. Conclusion:The pathogenesis of NSTEMI is deficiency in origin and excess in superficiality. Deficiency in origin is mostly Qi deficiency and Yin deficiency, while excess in superficiality is mostly blood stasis, phlegm and heat accumulation. traditional Chinese medicine therapies are mostly for invigorating Qi and nourishing Yin, promoting blood circulation and removing blood stasis, clearing heat and resolving phlegm.
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Background: Coronary artery disease (CAD) has emerged as a major health burden in developing countries. Many recent reports concluded that women with CAD have a worse prognosis than men and also with regards to invasive interventions when compared to men. In this study, author determined the comparative outcomes of ACS in women when compared with men.Methods: This study was conducted in a tertiary care hospital from November 2016 to March 2018. History taking, ECG, cardiac enzymes, 2D-Echo and angiogram were done to diagnose ACS and the appropriate treatment was given. The severity was assessed and compared the outcomes along with complications.Results: The total of 112 patients were treated for ACS, in which, 55 were females and the remaining 57 were males. Majority of the patients in both genders was between the ages of 51-60. In males, STEMI noted 50.8%, NSTEMI in 36.8%, UA in 12.2%. In females, STEMI is noted in 62%, unstable angina in 32.7%, NSTEMI in 27.2%. Six patients (11%) had mortality in the women group and one (1.8%) had died among men.Conclusions: Atypical presentation of ACS was more common in females. Women with ACS had higher complications and higher mortality than men.
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@#Objective To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
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Objective To investigate the clinical characteristics and prognostic factors after percutaneous coronary intervention of women with the first non-ST-segment elevation myoeardial infarction.Methods A total of 123 female patients with AMI,including 70 patients with NSTEMI and 53 patients with ST-segment elevation myocardial infarction (STEMI),who received PCI within 24 hours of onset were selected from June 2013 to June 2015.The clinical data were compared between patients with NSTEMI and with STEMI.Cox regression model was used to analyze the prognostic factors for the elderly patients with NSTEMI.Results The female patients with NSTEMI had more cases of patients with hypertension (48 vs.26),diabetes (38 vs.38) and hyperlipidemia (52 vs.29)than the female patients with STEMI.Significant differences in systolic blood pressure [(134.31±22.26)mmHg vs.(125.04 ± 19.63) mmHg],levels of white blood cell [(9.02 ± 3.75) 109/L vs.(11.37 ± 3.63) 109/L] and troponin Ⅰ [(8.63 ± 18.34) μg/L vs.(18.79 ± 27.76) μg/L] were observed in the above two groups (l P ＜ 0.05,respectively).The rates of revascularization,major adverse cardiovascular events in NSTEMI group were higher than those in STEMI group during 1 year after discharge (47.7％ vs.28.0％,62.9％ vs.35.8％) (P ＜ 0.05,respectively).Cox survival analysis showed that white blood cell (HR =1.241) and troponin-Ⅰ (HR =1.026) elevation were the risk prognostic factors after PCI for women with the first NSTEMI.Conclusion More hypertension,diabetes,hyperlipidemia and higher levels of systolic blood pressure,lower levels of white blood cell and troponin Ⅰ were observed in women with the first NSTEMI.The long-term prognosis of female patients with NSTEMI is poor.And elevated levels of white blood cell and troponin-Ⅰ were the risk prognostic factors after PCI for women with the first NSTEMI.
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Objective To investigate the effects of different anti thrombotic strategies on the risk of bleeding, cardiac events and quality of life in elderly patients with acute non ST segment elevation myocardial infarction.MethodsElderly patients with acute non ST elevation myocardial infarction 200 cases of complication in patients with atrial fibrillation, are in our hospital from May 2013 to December 2015 were cardiovascular department, after discharge according to different antithrombotic strategy, according to the 5 groups, including 40 cases of A group, 75mg/d+ 100mg/d treatment with clopidogrel and aspirin;B group 40 cases.Using warfarin therapy;40 cases in group C, 75mg/d or 100mg/d+ with clopidogrel aspirin warfarin therapy;40 cases in group D, using 75mg/d+ 100mg/d+clopidogrel aspirin warfarin therapy, group E received 75mg/d+ clopidogrel aspirin 100mg/d plus warfarin therapy, based on the use of psychological intervention.The risk of bleeding, cardiac events and quality of life scores were compared.ResultsStatistical analysis showed that the incidence of major cardiac events in E group (2.5%) and the quality of life were optimal (the data are statistically significant compared to P<0.05, A, B);C, D, E groups, the risk of major bleeding rate compared with no significant difference.ConclusionThe application of drugs and psychological intervention in the treatment of elderly patients with acute non ST segment elevation myocardial infarction patients can be more effective.
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Objective To investigate the relationship between admission blood glucose and in-hospital adverse events of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI) combined with multi-organ dysfunction in emergency department,and to assess the prognostic value.Methods Fifty-one geriatric patients with NSTEMI combined with multi-organ dysfunction were selected and divided into the experimental group (26 cases) and control group (25 cases),depending on whether they had adverse events in hospital.After the propensity score matching was used to reduce confounding effects,the difference in admission blood glucose between the two groups was compared.According to the ROC curve,the predictive value of immediate admission blood glucose to the incidence of adverse events during hospitalization was detected.Results After propensity score matching,admission blood glucose of the experimental group ((10.35±4.06) mmol/L) was higher than that of the control group ((7.05±2.45) mmol/L),and this difference was statistically significant (t=2.869,P<0.01).The area under the ROC curve for adverse events during hospitalization was 0.758 (P<0.01),and it may reach the best prognostic value when we choose 8.025mmol/L as the critical value.Under this condition,the sensitivity was 0.765 and specificity was 0.765.Conclusion For geriatric patients with NSTEMI combined with multi-organ dysfunction in emergency department,admission blood glucose is a risk factor for in-hospital adverse event,and the risk is high when admission blood glucose is over 8.025mmol/L.
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OBJECTIVE:To investigate the effects of loading-dose rosuvastain before early percutaneous coronary intervention (PCI) on reperfusion arrhythmias in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI).METHODS:A total of 136 patients with NSTEMI were randomly divided into loading-dose group (68 cases) and control group (68 cases).Both groups who were not given anti-platelet drugs were given loading-dose of Aspirin enteric-coated tablets 300 mg+Clopidogrel sulfate tablets 600 mg immediately after admission.The patients who were given aspirin regularly were given loading-dose of Clopidogrel sulfate tablets 600 mg only once after admission.The patients who were given clopidogrel regularly were given loading-dose of Aspirin enteric-coated tablets 300 mg only once.Those received PCI 12-24 h after medication.After PCI,they took Aspirin enteric-coated tablets 100 mg for life+Clopidogrel bisulfate tablets 75 mg at least 12 months.Loading-dose group was given loading-dose of Rosuvastatin calcium tablets 20 mg orally,12 h before surgery.All patients began to take Rosuvastatin calcium tablets 10 mg,once a day,since the night after the operation.Coronary angiography and the occurrence of reperfusion arrhythmia were observed in 2 groups.The levels of CK-MB and cTnT,major adverse cardiovascular events (MACE) were observed before and after surgery.RESULTS:There was no statistical significance in the number of diseased vessels,culprit vessels,the degree of culprit vessels stenosis or the incidence of MACE between 2 groups (P＞ 0.05).The incidence of reperfusion arrhythmia in loading-dose group was significantly lower than control group,with statistical significance (P＜0.01).There was no statistical significance in the degree of culprit vessels stenosis between 2 groups (P＞0.05).Before surgery,there was no statistical significance in the levels of CK-MB or cTnT between 2 groups (P＞0.05).After surgery,the levels of CK-MB and cTnT in 2 groups were significantly higher than before surgery,but the loading-dose group was significantly lower than the control group,with statistical significance (P＜0.01).CONCLUSIONS:Preoperative loading-dose of rosuvastatin before PCI can reduce the incidence of reperfusion arrhythmias in NSTEMI patients.
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OBJECTIVE:To investigate the effects of intensive atorvastatin therapy on postoperative blood lipid,inflammation reaction and major adverse cardiac events (MACE) in non-ST segment elevation myocardial infarction (NSTEMI) patients before PCI.METHODS:A total of 120 NSTEMI patients underwent selective PCI were randomly divided into control group (60 cases) and observation group (60 cases).Both groups were given Aspirin enteric-coated tablet 0.3 g orally,once a day+Clopidogrel sulfate tablet 300 mg orally,once a day,immediately after admission.After operation,they were given medicine continuously for consecutive 12 weeks.Control group was given Atorvastatin calcium tablet 80 mg orally,immediately after operation,and then was given 40 mg,once a day,for consecutive 12 weeks.Observation group was additionally given Atorvastatin calcium tablet 40 mg orally 6 h before operation on the basis of control group.The levels of TG,TC,HDL-C,LDL-C,hs-CRP,TNF-αt and IL-10 before and after PCI,the incidence of postoperative MACE,postoperative re-hospitalization rate and the occurrence of ADR were observed in 2 groups.RESULTS:There was no statistical significance in the levels of TG,TC,HDL-C or LDL-C between 2 groups before and after operation (P＜0.05).After operation,the levels of hs-CRP,TNF-α and IL-10 in 2 groups were significantly higher than before operation,and the observation group was significantly lower than the control group,with statistical significance (P＜ 0.05).There was no statistical significance in the incidence of postoperative MACE,postoperative re-hospitalization rate or the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Intensive atorvastatin therapy before PCI can effectively reduce the levels of inflammatory response in NSTEMI patients,but have no significant changes in blood lipid levels and MACE risk,without increasing the incidence of ADR.
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Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.
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As doenças cardiovasculares, principal causa de morte em nosso país e na maioria dos países, resultam de diversos fatores de risco. O infarto agudo do miocárdio apresenta-se de duas maneiras: com supradesnivelamento do segmento ST (IAMCSST) e sem supradesnivelamento do segmento ST (IAMSSST). A abordagem terapêutica do IAMSSST baseia-se na estratificação de risco, podendo ser realizada através do escore TIMI. O objetivo desse estudo foi verificar os fatores de risco para doenças cardiovasculares e a relação entre o escore TIMI de pacientes com IAMSSST e o tempo para realização da cinecoronariografia. Estudo transversal, prospectivo com componente analítico, realizado no período de 01 de agosto de 2011 a 30 de novembro de 2011.O censo foi constituído de 97 pacientes com diagnóstico de IAMSSST. Verificou-se que a maioria dos pacientes era do sexo masculino (56,7%). A idade média dos pacientes foi de 63 anos, sendo a hipertensão arterial sistêmica o fator de risco mais frequente. O escore TIMI mais prevalente foi o intermediário, o tempo para realização da conduta invasiva foi o tardio e a terapêutica mais prevalente a angioplastia. Dentre o total de pacientes, 81,5% foram submetidos à cinecoronariografia, sendo que 37,9% foram submetidos precocemente e 62,1% tardiamente. A frequência de cinecoronariografia precoce foi 53% maior nos pacientes de alto risco quando comparados com os de baixo risco (p>0,05). Os principais fatores de risco para doenças cardiovasculares foram: hipertensão arterial sistêmica, dislipidemia, tabagismo, história familiar, diabetes e obesidade. Quanto maior o escore TIMI, mais precoce foi a realização da cinecoronariografia.
Cardiovascular diseases are the leading cause of deaths in our country, as well as in most countries, due to several risk factors. Acute myocardial infarction can occur in two ways: ST-segment elevation (STEMI) and non-ST-segment elevation (NSTEMI). The therapeutic approach of NSTEMI based on risk-stratification can use the TIMI risk score. The objectives were to verify the risk factors for cardiovascular diseases, and the relation between the TIMI risk score of patients with NSTEMI and the time to start performing the coronary angiography. Cross-sectional, prospective analytical study made from august 01st 2011 to November 30th 2011.The census was carried out in 97 patients diagnosed with NSTEMI. It was found that most patients were men (56,7%). The average age of these patients was 63 years old, and systemic arterial hypertension was the most common risk factor. The most prevalent TIMI risk score was intermediate, delayed invasive intervention was performed and the most common therapy was angioplasty. Among the 97 patients, 81,5% were submitted to coronary angiography, from this total, 37,9% to early invasive intervention and 62,1% to delayed invasive intervention. The frequency of early coronary angiography was 53% superior in high-risk patients when compared to those of low-risk (p>0,05).The main risk factors for cardiovascular diseases were: systemic arterial hypertension, dyslipidemia, smoking, family history, diabetes and obesity. The higher the TIMI risk score, the earlier coronary angiography was performed.
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In the not too distant future, high-sensitivity cardiac troponin assays will be introduced for use in the United States. They bring with them many exciting new opportunities within cardiovascular practice including the ability to confirm or refute a diagnosis of acute myocardial infarction more rapidly as well as the ability to risk stratify and guide treatment decisions in patients with a variety of acute and chronic noncoronary diseases. However, clinicians and researchers must be aware of the new facets introduced with troponin testing and, in particular, the new issues that will arise with high sensitivity assays. Emphasis must also be placed on reiterating the same principles of the effective use of troponin testing that applied to conventional assays, as these are likely to become even more important. This review outlines a number of important issues related to high sensitivity assays with a focus on their use in acute hospital settings.
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Adolescente de 18 años con gestación de 38 semanas, consulta en su comunidad por cuadro de 3 días de dificultad respiratoria progresiva y cefalea. Se acompaña de edema de miembros inferiores y cifras tensionales elevadas. Ante episodio de convulsiones tónico clónicas generalizadas es remitida al Hospital Nacional. Ingresa al Departamento de Gineco- obstetricia con diagnóstico de eclampsia. Se indica cesárea de urgencia. El electrocardiograma revela infra desnivel del segmento ST en cara anterior, lateral, septal y apical, se detecta elevación de enzimas cardiacas y aumento de troponina I. Se realiza el diagnóstico de un infarto agudo de miocardio sin elevación del ST. La ecocardiografía transtorácica constata aquinesia anterior, septal y apical e hipoquinesia del resto de los segmentos con una fracción de eyección 28-32%. La paciente presenta evolución favorable. Una semana después, el electrocardiograma es normal, la ecocardiografía transtorácica de control revela persistencia de los cambios en la motilidad del VI con mejoría de la fracción de eyección (48%). Al mes del evento, la ecocardiografía muestra función sistólica normal con fracción de eyección 60%, sin alteraciones residuales de la motilidad.
An 18-year adolescent with a 38-week pregnancy looks for medical attention in her community due to a progressive respiratory difficulty of three-day evolution. She also presents lower extremities edema and arterial hypertension. Due to tonic-clonic seizures, the patient is admitted into the Department of Gyneco-Obstetrics of the National Hospital with a diagnosis of eclampsia and an urgent cesarean section is indicated. The electrocardiogram shows a ST-segment depression in the anterior, lateral, septal and apical sides. Elevated cardiac enzymes and increase of troponin I are also detected. Extensive acute myocardial infarction not Q is diagnosed. The transthoracic echocardiography shows anterior, septal and apical akinesia and hypokinesia of the remaining segments with an ejection fraction of 28-32%. The patient presents a favorable evolution. A week later, the electrocardiogram is normal and the control transthoracic echocardiography reveals persistent changes in the motility of the LV with improvement of the ejection fraction (48%). One month after the event, the echocardiography shows normal systolic function with an ejection fraction of 60% without residual alterations of the motility
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BACKGROUND: Morbidity and mortality from acute coronary syndrome (ACS) primarily depends on prompt evaluation and management of patients. Despite available recommendations on ACS management, there is limited data regarding Filipino physician's knowledge and adherence with these guidelines in the emergency room (ER).OBJECTIVES: To describe the initial management of ACS patients by Filipino physicians at the ER and to document their adherence with the 2007 American College of Cardiology/American Heart Association (ACC/AHA) ACS guidelines for the management of patients with unstable angina (UA)/ non-ST-segment elevation myocardial infraction (NSTEMI) and ST-segment elevation myocardial infraction (STEMI).METHODS: This was an open-label, descriptive, multicenter, non-interventional study that enrolled patients ? 18 years of age, seen at the ER and suspected to have UA or MI with or without ST-segment elevation. Patient demographics, medical history, physical and laboratory examinations, medications or interventions done at the ER and the specialty of physicians who provided the initial management were recorded. Adherence with the 2007 ACC/AHAACS guidelines was also assessed. Data were summarized using descriptive statistics.RESULTS: A total of 1,398 eligible patients (mean age 61.58+ 12.03 years) were included in the study. At least one cardiac enzyme test was requested in up to 93% of patients, with troponin I being the most common (72.53%). Upon diagnosis, 95.78% of patients were given antiplatelet therapy (16.95% clopidogrel alone, 15.31% aspirin alone and 1.07% other antiplatelet drugs), the combination therapy. Moreover, 86.27% were given anticoagulant therapy (75.75% enoxaparin, 5.94% fondaprinux and 3.97% IV UFH). Ninety-eight percent of patients we subsequently admitted in the hospital and 26.68% of patients were considered to undergo percutaneous coronary intervention (PCI). Majority of these patients were initially managed by ER physicians (52.22%).CONCLUSION: Filipino physicians at the ER provide an appropriate management strategy to individual ACS patients because their management adheres to the 2007 and the current ACC/AHA ACS guidelines. The outcome and impact of these strategies should be assessed to encourage more physicians to conform with available recommendations. Moreover, a review of adherence of physicians to other disease management guidelines should be conducted to further improve care and outcomes in ER.
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Humans , Male , Female , Aged , Middle Aged , Acute Coronary Syndrome , American Heart Association , Angina, Unstable , Anticoagulants , Aspirin , Disease Management , Emergency Service, Hospital , Enoxaparin , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors , Ticlopidine , Troponin I , United States , Myocardial InfarctionABSTRACT
OBJECTIVE: To discuss the positive rate of ventricular late potential (VLP) between patients with acute ST-segment elevation myocardial infarction (STEMI) and patients with acute non NSTEMI. METHODS: One hundred and sixty-three cases of acute myocardial infarction (90 patients with STEMI and 73 with NSTEMI), admitted to the first hospital of China Medical University between June 2011 and August 2011, underwent VLP examination. RESULTS: The VLP positive rate of the STEMI group was 54.4%, while that of the NSTEMI group was 38.4%, and the differences have statistical meaning (χ2 = 4.186, p < 0.05). The occurrence rate of ventricular arrhythmia in VLP positive patients was 11.7%, while in VLP negative patients it was 3.5% (χ2 = 4.005, p < 0.05). CONCLUSION: The VLP positive rate of the STEMI group is higher than that of the NSTEMI group.
OBJETIVO: Analizar la tasa positiva del potencial tardío ventricular (PTV) entre pacientes con infarto agudo del miocardio sin elevación del segmento ST (NSTEMI por sus siglas en inglés) y el infarto agudo del miocardio con elevación del segmento ST (STEMI por sus siglas en inglés). MÉTODOS: Ciento sesenta y tres casos de infarto agudo de miocardio (90pacientes con STEMI) y 73 con NSTEMI, ingresados en la Universidad primer hospital de Medicina China entre junio y agosto de 2011, fueron sometidos a examen de PTV. RESULTADOS: La tasa positiva PVT del grupo STEMI fue 54.4%, mientras que la del grupo NSTEMI fue 38.4%, y las diferencias tienen significado estadístico (χ² = 4.186, p < 0.05). La tasa de ocurrencia de arritmia ventricular en pacientes PVTpositivos fue 11.7%, mientras que en los pacientes PVT negativos fue 3.5% (χ² = 4.005, p < 0.05). CONCLUSIÓN: La tasa PTV positiva del grupo STEMI es mayor que la del grupo NSTEMI.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Ventricular Fibrillation/physiopathology , Ventricular Dysfunction/physiopathology , Non-ST Elevated Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/physiopathology , ElectrocardiographyABSTRACT
Background: Nearly 40% of patients presenting with Non ST-Segment Elevation Myocardial Infarction (NSTEMI) have Chronic Kidney Disease (CKD). CKD is a powerful predictor of adverse events among NSTEMI patients. The purpose of the present study was to evaluate the in-hospital outcome of patients with Chronic Kidney Disease presenting with Non ST-Segment Elevation Myocardial Infarction. Methods: In this prospective observational study a total of 128 patients with NSTEMI were enrolled. They were divided equally in group I (NSTEMI with CKD) and group II (NSTEMI with normal renal function) on the basis of estimated glomerular filtration rate. Patients were considered to have CKD if he/she had documented history of CKD or estimated glomerular filtration rate <60 mL/min/1.73 m². Presence of inhospital complications was identified. Results: Patients with CKD were significantly older, with a greater prevalence of hypertension, diabetes mellitus, lower left ventricular ejection fraction, and lower haemoglobin level compared with those without CKD. CKD patients had more atypical presentation during admission. In-hospital complications were significantly higher in CKD patients presenting with NSTEMI. Conclusion: CKD strongly predicts adverse in-hospital outcome among NSTEMI patients.
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Objective To investigate the relationship between CRP, plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 gene promoter 4G/5G polymorphism and the type of acute myocardial infarction (ST elevation myocardial infarction, STEMI vs the non-ST elevation Myocardial infarction, NSTEMI). Methods One hundred seventy-six consecutive patients with AMI were included for the study, of whom 60 had STEMI and 56 had NSTEMI, and 60 adults without cardiovascular and cerebrovascular disease were selected as controls. Blood samples were obtained from patients within 6 h of AMI and the plasma PAI-1, CRP, and the gene polymorphism were measured. Results Plasma levels of PAI-1 and CRP were higher in AMI groups, compared those in the control group, and plasma levels of PAI-1 were significantly higher in patients with STEMI compared to those with NSTEMI (80.12ng/ml VS.73.01ng/ml, P 0.05). PAI-1 levels presented a significant correlation with CRP levels in the NSTEMI subjects. However, PAI-1 and CRP levels could explain the lack of a significant relationship between them in control and STEMI subjects.The frequencies of 4G/4G genotype in the AMI group were higher than those in the control group and higher in patient with STEMI than in patient with NSTEMI. Plasma levels of PAI-1 in subjects with 4G/4G genotype were significantly increased as compared to those in subjects with 4G/5G and 5G/5G genotype. Conclusions Plasma PAI-1 levels were associated with different myocardial infarction type, and PAI-1 promoter 4G/5G polymorphisms and CRP may be related to plasma PAI-1 levels.
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Objective To investigate the effect of sodium ozagrel injection on hemorheology, endothelin (ET) and nitrogen monoxidum (NO) of patients with non-ST segment elevation myocardial infarction (NSEMI). Methods A total of 81 NSEMI patients were divided randomly into two groups: control group and experimental group. Isosorbide mononitrate, low molecular heparin and simvastatin were administered in the control group while sodium ozagrel was added to the experimental group apart from the above-mentioned drugs. The clinical effect of sodium ozagrel was observed. The changes in the indexes of hemorheology, ET and NO were analyzed. Results The clinical effect was significantly better in the experimental group than in the control group (P<0.05). The level of ET was obviously lower after treatment than that in the experimental group and the control group before treatment (P<0.05). The level of NO was obviously higher after treatment than that in the experimental group and the control group before treatment (P<0.05). The changes of ET and NO in the experimental group post-treatment were more significant than those in the control group after-treatment (P<0.05). The level of hemorheology index after treatment was lower than that before treatment in the experimental group (P<0.05). High-shear rate of whole blood viscosity, platelet adherence rate, and fibrin as hemorheology indexes were lower after-treatment than those pretherapy in the control group (P<0.05). Conclusion Sodium ozagrel injection could affect hemorheology,ET and NO of patients with non-ST segment elevation myocardial infarction. Thefore, the therapeutic efficacy can be better if sodium ozagrel is added to the conventional therapy.
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Objective To study the clinical characteristics of acute non-ST segment elevation myocardial infarction(NSTEMI).Methods 211 patients of NSTEMI and STEMI underwent coronary artery angiography and echocardiogram.Patients'history and symptome were collected and the data of coronary artery angiography and echocardiogram were analyzed.Results Compared with STEMI,NSTEMI patients had more risk factors and postinfarction angina pectoris;severe coronary artery disease and three coronary vessel disease.But NSTEMI had relatively little effects on cardiac function.Conclusion NSTEMI always has more severe coronary artery disease and postinfarction ischemic effects.So more attention should be paid to its standard therapy.