El puntaje de Framingham ayudaría en la estratificación del riesgo de pacientes con ergometría positiva y SPECT normal / The Framingham score could help in risk stratification of patients with positive ergometry and normal SPECT

Antecedentes. El valor pronóstico de una ergometría positiva en el contexto de imágenes tomográficas de perfusión miocárdica de estrés y reposo (SPECT) normales no está bien establecido. Objetivos. Documentar la incidencia de infarto, muerte y revascularización coronaria en pacientes con una ergometría positiva de riesgo intermedio e imágenes de perfusión SPECT normales, y explorar el potencial valor del puntaje de riesgo de Framingham en la estratificación pronóstica de estos pacientes. Métodos. Cohorte retrospectiva integrada por pacientes que habían presentado síntomas o hallazgos electrocardiográficos compatibles con enfermedad arterial coronaria durante la prueba de esfuerzo, con criterios de riesgo intermedio en la puntuación de Duke y perfusión miocárdica SPECT normal. Fueron identificados a partir de la base de datos del laboratorio de cardiología nuclear del Instituto de Cardiología y Cirugía Cardiovascular de la ciudad de Posadas, Argentina. Resultados. Fueron elegibles 217 pacientes. El seguimiento fue de 3 1,5 años. La sobrevida libre de eventos (muerte,infarto de miocardio no fatal, angioplastia coronaria o cirugía de bypass de arteria coronaria) a uno, tres y cinco años fue significativamente menor (Log-rank test, p= 0,001) en el grupo con puntaje de Framingham alto o muy alto (77, 71y 59 %, respectivamente) que en el grupo de puntaje bajo o intermedio (89, 87 y 83 %). Tomando como referencia a los pacientes con riesgo bajo en el puntaje de Framingham, luego de ajustar por edad, sexo y puntaje de Duke, los pacientes categorizados en los estratos alto y muy alto riesgo del puntaje de Framingham presentaron una incidencia del evento combinado cercana al triple (hazard ratio [HR] 2,81; intervalo de confianza [IC] del 95 % 0,91 a 8,72; p= 0,07 y HR 3,61;IC 95 % 1,23 a 10,56; p= 0,019 respectivamente). Conclusiones. La estimación de riesgo con el puntaje de Framingham sería de ayuda en la estratificación pronóstica de los pacientes con ergometría positiva y SPECT normal. (AU)

Background. The prognostic value of positive exercise testing with normal SPECT myocardial perfusion imaging is not well established. Objectives. To document the incidence of infarction, death, and coronary revascularization in patients with a positive intermediate-risk exercise test and normal SPECT perfusion images and to explore the potential value of the Framingham Risk Score in the prognostic stratification of these patients. Methods. A retrospective cohort comprised patients who presented symptoms or electrocardiographic findings compatible with coronary artery disease during the stress test, with intermediate risk criteria in the Duke score and normal SPECT myocardial perfusion. They were identified from the database of the nuclear cardiology laboratory of the Instituto de Cardiología y Cirugía Cardiovascular of Posadas, Argentina. Results. 217 patients were eligible. Follow-up was 3 1.5 years. Event-free survival (death, non-fatal myocardial infarction, coronary angioplasty, or coronary artery bypass surgery) at one, three, and five years was significantly lower (Log-ranktest, p: 0.001) in the group with a score of Framingham high or very high (77, 71 and 59 %, respectively) than in the lowor intermediate score group (89, 87 and 83 %). Taking as reference the low-risk patients in the Framingham score, after adjusting for age, sex, and Duke score, the patients categorized in the high-risk and very high-risk strata showed about three times higher incidence of the combined event (hazard ratio [HR] 2.81; 95 % confidence interval [CI] 0.91 to 8.72;p=0.07 and HR 3.61; 95 % CI 1.23 to 10.56; p=0.019 respectively). Conclusions. Risk estimation with the Framingham score would be helpful in the prognostic stratification of patients with positive exercise testing and normal SPECT. (AU)

El dilema clínico frente a los pacientes con ergometría positiva y prueba de perfusión miocárdica con SPECT normal / The clinical dilemma facing patients with positive stress test and normal SPECT myocardial perfusion imaging

La evaluación de la perfusión miocárdica con SPECT combina una prueba de esfuerzo (ergometría o estrés farmacológico) junto a imágenes de perfusión con radioisótopos. Este estudio es útil para establecer el diagnóstico de enfermedad arterial coronaria, estratificar el riesgo de infarto y tomar decisiones terapéuticas. Un resultado normal aporta un alto valor predictivo negativo, es decir, una muy baja probabilidad de que el paciente presente eventos cardiovasculares. El hallazgo de signos de isquemia en la ergometría podría poner en jaque el valor predictivo negativo de una perfusión normal. En presencia de este resultado, el paso siguiente es evaluar los predictores de riesgo en la ergometría, el riesgo propio del paciente en función de los antecedentes clínicos y el puntaje cálcico coronario, cuando este se encuentra disponible. Ante la presencia concomitante de otros marcadores de riesgo se sugiere completar la evaluación con un estudio anatómico.El uso de nuevas tecnologías podría mejorar la precisión en la predicción de eventos. (AU)

Assessment of myocardial perfusion with SPECT combines a stress test (ergometry or pharmacological stress) with radioisotope perfusion imaging. This test is helpful to diagnose coronary artery disease, stratify the risk of heart attack, and make therapeutic decisions. A normal result provides a high negative predictive value; therefore, the probability of cardiovascular events is very low. Signs of ischemia on an ergometry could jeopardize the negative predictive value of normal perfusion. In this clinical setting, the next step is to evaluate the risk predictors in the stress test, the individual risk based on the clinical history, and the coronary calcium score when available. Given the simultaneous presence of other risk markers,completing the evaluation with an anatomical study is suggested. The use of new technologies could improve the accuracy of event prediction. (AU)

Neutrófilos en el diagnóstico de infarto del miocardio tipo 4a / Neutrophils in the Diagnosis of Type 4 Myocardial Infarction

Introducción: El infarto del miocardio tipo 4a es una complicación del intervencionismo coronario percutáneo que incrementa el estado inflamatorio de los pacientes. Objetivo: Evaluar el valor diagnóstico del conteo absoluto de neutrófilos en la aparición de infarto del miocardio tipo 4a. Métodos: Se realizó una cohorte prospectiva en el Hospital Hermanos Ameijeiras. El universo estuvo constituido por 412 pacientes a los que se les realizó intervencionismo coronario percutáneo en el período comprendido de noviembre de 2018 a enero de 2021, la muestra fue de 232 pacientes. Se definieron variables clínicas, anatómicas, e inflamatorias. Resultados: Existieron diferencias significativas entre los pacientes con infarto tipo 4a y los que no tuvieron esta complicación según las variables clínicas: edad, índice de masa corporal, diabetes mellitus, enfermedad renal crónica y disfunción sistólica ventricular. La elevación del conteo absoluto de neutrófilos posterior al proceder con un área bajo la curva de 0,947 tuvo buena capacidad de discriminación de esta complicación (p = 0,000). En el diagnóstico de infarto periproceder el conteo absoluto de neutrófilos fue 7,35 posterior al proceder, tuvo una sensibilidad de 91,3 por ciento una especificidad de 96,2 por ciento. Conclusiones: Los neutrófilos fueron sensibles y específicos para el diagnóstico de infarto del miocardio tipo 4a(AU)

Introduction: Type 4 myocardial infarction is a complication of percutaneous coronary intervention that increases the inflammatory state of patients. Objective: To evaluate the diagnostic value of the absolute neutrophil count in the occurrence of type 4 myocardial infarction. Methods: A prospective cohort was carried out at Hermanos Ameijeiras Clinical Surgical Hospital. The universe consisted of 412 patients who underwent percutaneous coronary intervention from November 2018 to January 2021, two hundred thirty-two (232) patients form the sample. Clinical, anatomical and inflammatory variables were defined. Results: There were significant differences between patients with type 4 infarction and those who did not have this complication according to the clinical variables such as age, body mass index, diabetes mellitus, chronic kidney disease and ventricular systolic dysfunction. The subsequent elevation of the absolute neutrophil count when proceeding with an area under the 0.947 curve had good ability to discriminate this complication (p = 0.000). In the diagnosis of periprocedural infarction, the absolute neutrophil count was ≥ 7.35 after the procedure, it had 91.3percent sensitivity and 96.2percent specificity. Conclusions: Neutrophils were sensitive and specific for the diagnosis of type 4 myocardial infarction(AU)

Interleukin-37 has A Promising Cardioprotective Effect on Isoproterenol-Induced Myocardial Infarction / La Interleucina-37 tiene un Efecto Cardioprotector Prometedor sobre el Infarto de Miocardio Inducido por Isoproterenol

SUMMARY: The main cause of mortality and disability globally is myocardial infarction (MI). Isoproterenol (ISO), a β-adrenoceptor agonist, has been used to induce rat myocardial necrosis. Whereas interleukin-37 (IL-37) has anti-inflammatory and cytoprotective properties. The study aimed to investigate the potential protective effects of IL-37 administration on cardiac architecture, oxidative stress, and inflammatory markers during ISO-induced MI in rats. Three groups of adult male rats were used in this study, the normal control group (n=8), ISO-induced MI group (n=8) that received isoproterenol hydrochloride (ISO) (100 mg/kg/day, SC, for the first 2 consecutive days), and IL-37-treated group (ISO+IL-37) (n=8) that received recombinant human IL-37 (40 µg/kg /day, intraperitoneally, for 2 weeks during and after ISO injections. Heart rate (HR.) and ECG changes were monitored. Some oxidative stress markers such as superoxide dismutase (SOD), nitric oxide (NOx), malondialdehyde (MDA), and glutathione (GSH) tissue levels in the tissue homogenate were assayed. Interleukin- 6 (IL-6), tumor necrosis factor- α (TNF-α), caspase-8, P53, and C- reactive protein (CRP) were among the inflammatory markers examined. In addition, serum levels of creatinine kinase (CK-MB) and lactate dehydrogenase (LDH) were analyzed to evaluate the myocardial injury. For histological analysis, tissues were sectioned, fixed in paraffin, and stained with hematoxylin and eosin (H&E), Masson Trichrome and, immunohistochemical against NF-kB, TNF-α, and Caspase-9. IL-37 improved ECG changes, cardiac enzyme markers, and some inflammatory markers of oxidative stress in ISO-induced MI. It also improved the histopathological and immunohistochemical changes in MI. In conclusion: IL-37 might be a promising therapeutic modality in myocardial infarction.

La principal causa de mortalidad y discapacidad a nivel mundial es el infarto de miocardio (IM). El isoproterenol (ISO), un agonista de los receptores adrenérgicos β, se ha utilizado para inducir necrosis miocárdica en ratas. Mientras que la interleucina-37 (IL-37) tiene propiedades antiinflamatorias y citoprotectoras. El estudio tuvo como objetivo investigar los posibles efectos protectores de la administración de IL-37 en la arquitectura cardíaca, el estrés oxidativo y los marcadores inflamatorios durante el infarto de miocardio inducido por ISO en ratas. En este estudio se utilizaron tres grupos de ratas macho adultas, el grupo control normal (n=8), el grupo con IM inducido por ISO (n=8) que recibió clorhidrato de isoproterenol (ISO) (100 mg/kg/día, SC, durante los primeros 2 días consecutivos) y el grupo tratado con IL-37 (ISO+IL- 37) (n=8) que recibió IL-37 humana recombinante (40 µg/kg/día, por vía intraperitoneal, durante 2 semanas durante y después de las inyecciones de ISO. Se monitorearon la frecuencia cardíaca (FC) y los cambios en el ECG. Se analizaron algunos marcadores de estrés oxidativo como la superóxido dismutasa (SOD), el óxido nítrico (NOx), el malondialdehído (MDA) y los niveles tisulares de glutatión (GSH) en el homogeneizado de tejido. La interleucina-6 (IL-6), el factor de necrosis tumoral-α (TNF-α), la caspasa-8, la P53 y la proteína C reactiva (CRP) se encontraban entre los marcadores inflamatorios examinados. Se analizaron los niveles de creatinoquinasa (CK-MB) y lactato deshidrogenasa (LDH) para evaluar la lesión miocárdica; para el análisis histológico se seccionaron los tejidos, se fijaron en parafina y se tiñeron con hematoxilina y eosina (H&E), Tricromo de Masson e inmunohistoquímica contra NF-kB, TNF-α y Caspasa-9. IL-37 mejoró los cambios de ECG, los marcadores de enzimas cardíacas y algunos marcadores inflamatorios de estrés oxidativo en el IM inducido por ISO. Además mejoró los cambios histopatológicos e inmunohistoquímicos en MI. En conclusión: la IL-37 podría ser una modalidad terapéutica prometedora en el infarto de miocardio.

Intervención psicoeducativa para potenciar la rehabilitación cardiovascular integral en pacientes convalecientes de infarto agudo de miocardio / A psychoeducational intervention to enhance comprehensive cardiovascular rehabilitation in patients convalescent from acute myocardial infarction

Introducción: La rehabilitación cardiovascular integral del paciente con infarto agudo de miocardio resulta fundamental para el logro de su bienestar físico y psicológico, y su reinserción a la vida social. Objetivo: Elaborar una estrategia de intervención psicoeducativa para potenciar la rehabilitación cardiovascular integral en pacientes convalecientes de infarto agudo de miocardio, con la visión de especialistas consultados. Métodos: Se realizó un estudio observacional, descriptivo y de corte transversal en el Hospital Universitario «Dr. Celestino Hernández Robau», de Santa Clara, entre octubre de 2019 y enero de 2021. La muestra estuvo conformada por 27 pacientes que asistieron a la consulta de Cardiología, y 7 especialistas según criterios de inclusión. Las técnicas aplicadas fueron: la revisión de historia clínica, entrevistas semiestructuradas a pacientes y especialistas, la encuesta sobre el conocimiento de la enfermedad, un autorreporte vivencial y la evaluación del estilo vida. Se utilizaron estadísticos descriptivos acorde a la medición de las variables, análisis de contenido y triangulación de la información. Resultados: En los pacientes diagnosticados con estilo de vida poco saludable, predominó un conocimiento medianamente suficiente de la enfermedad; la hipertensión arterial fue el principal factor de riesgo asociado. Se elaboró la estrategia de intervención según las necesidades psicoeducativas identificadas por los pacientes con la visión de especialistas consultados. Se constató que presentan carencia de habilidades para autocontrolar las reacciones emocionales posteriores al suceso cardiovascular. Conclusiones: La estrategia elaborada fue valorada satisfactoriamente por juicio de profesionales, indicándose la posibilidad de ser aplicada en los usuarios a los que está dirigida.

Introduction: comprehensive cardiovascular rehabilitation of patients with acute myocardial infarction is essential to achieve their physical and psychological well-being, and their reintegration into social life. Objective: to develop a psychoeducational intervention strategy to enhance comprehensive cardiovascular rehabilitation in patients convalescent from acute myocardial infarction, with the vision of consulted specialists. Methods: an observational, descriptive and cross-sectional study was carried out at "Dr. Celestino Hernández Robau" University Hospital, in Santa Clara, between October 2019 and January 2021. The sample consisted of 27 patients who come to the Cardiology consultation, and 7 specialists according to inclusion criteria. Medical history review, semi-structured interviews with patients and specialists, a survey on knowledge of the disease, an experiential self-report, and a lifestyle evaluation were the techniques applied. Descriptive statistics were used according to the measurement of the variables as well as content analysis and triangulation of the information. Results: a moderately sufficient knowledge of the disease prevailed in patients diagnosed with an unhealthy lifestyle; arterial hypertension was the main associated risk factor. The intervention strategy was developed according to the psychoeducational needs identified by the patients with the vision of the consulted specialists. We verified that they have a lack of abilities to self-control their emotional reactions after the cardiovascular event. Conclusions: the elaborated strategy was satisfactorily valued by professional judgment, which indicates the possibility of being applied to the users to whom it is directed.

Incidência e fatores de risco associados ao infarto agudo do miocárdio sem obstrução coronariana / Incidence and risk factors associated with acute myocardial infarction with nonobstructive coronary arteries / Incidencia y factores de riesgo associados al infarto agudo de miocardio sin obstrucción coronaria

Objetivo: identificar a incidência, fatores de risco e desfechos associados ao infarto agudo do miocárdio sem obstrução de artérias coronárias (myocardial infarction with nonobstructive coronary arteries ­ MINOCA). Método: estudo de coorte prospectivo em prontuários clínicos num hospital terciário do extremo Sul catarinense. Foram incluídos pacientes diagnosticados com infarto agudo do miocárdico (IAM) submetidos a estudo hemodinâmico nos anos de 2017 e 2018. Resultados: ao analisar 445 prontuários, observou-se a ocorrência de MINOCA em 28 pacientes (6,3%). Comparando o grupo MINOCA com o grupo IAM obstrutivo, os pacientes do grupo MINOCA eram mais jovens, com média de 54 anos (DP ± 14; p=0,007), tinham menor incidência de tabagismo (2 versus 156, p<0,001), hipertensão arterial (10 versus 242; p=0,002), menor tempo médio (dias) de internação hospitalar (5,79 ± 3,05 versus 7,49 ± 5,20; p= 0,02) e menos admissões em unidade de tratamento intensivo (5 versus 212; p=0,002). Conclusão: a incidência de MINOCA estimada dentre o total de IAM no Sul de Santa Catarina foi de 6,3% [IC 95]. Os pacientes do grupo MINOCA tiveram menor prevalência de comorbidades, melhor evolução intra-hospitalar e melhor desfecho.

Objective: to identify the incidence, risk factors and outcomes associated with myocardial infarction with nonobstructive coronary arteries (MINOCA). Method: it is a with prospective cohort study data collection from medical records data. Patients with acute myocardial infarction (AMI) that went through hemodynamic study in 2017 and 2018 were included. Results: when analyzing 445 medical records, the occurrence of MINOCA was observed in 28 patients (6.3%). Comparing the MINOCA group with the obstructive AMI group, patients in the MINOCA group were younger, with a mean age of 54 years (SD ± 14; p=0.007), had a lower incidence of smoking (2 versus 156, p<0.001), hypertension (10 versus 242; p=0.002), shorter mean length of hospital stay (days) (5.79 ± 3.05 versus 7.49 ± 5.20; p= 0.02) and fewer admissions to intensive care unit (5 versus 212; p=0.002). Conclusion: the estimated incidence of MINOCA among the total number of AMI in southern Santa Catarina was 6.3% [CI 95]. Patients in the MINOCA group had a lower prevalence of comorbidities, better in-hospital evolution and better outcome.

Práticas clínicas aplicadas a pacientes com infarto do miocárdio sem obstrução de artéria coronária (minoca) / Clinical Practices Applied To Patients With Myocardial Infarction Non-obstruction Coronary Arteries (Minoca) / Prácticas clínicas aplicadas a pacientes con infarto e miocardio sin obstruccion arteria coronaria (MINOCA)

Objetivo: Identificar práticas clínicas com resultados favoráveis aos pacientes com diagnóstico de infarto agudo do miocárdio sem obstrução de artéria coronária. Método: Revisão integrativa da literatura pela base de dados National Library of Medicine e Biblioteca Virtual de Saúde de estudos publicados entre 2018 e 2022. Resultados:87,5% dos estudos encontrados destacaram estratégias farmacológicas e destes, 62,5% citaram o uso da dupla antiagregaçãoplaquetária como mais utilizada, apesar de nenhum estudo evidenciar benefícios. Os inibidores do sistema renina-angiotensina-aldosterona comprovaram benefícios em três estudos. 75% dos artigos apontaram que esse grupo de pacientes recebem menos medicamentos preventivos comparados aos pacientes com infarto por obstrução coronariana. Outros seis estudos, revelaram condução clínica variável desses pacientes. Conclusão: O uso de inibidores do sistema renina-angiotensina-aldosterona deve ser considerado por ser a única medicação com redução da mortalidade evidenciada. São necessários estudos maiores para orientar com mais segurança à condução do infarto do miocárdio sem obstrução de coronária.(AU)

Objective: To identify clinical practices with favorable results for patients diagnosed with acute myocardial infarction without coronary artery obstruction. Method: Integrative literature review using the National Library of Medicine and Virtual Health Library databases of studies published between 2018 and 2022. Results: 87.5% of the studies found highlighted pharmacological strategies and of these, 62.5% cited the use of dual antiplatelet therapy as the most used, despite no study showing benefits. Inhibitors of the renin-angiotensin-aldosterone system have shown benefits in three studies. 75% of the articles pointed out that this group of patients receive less preventive medication compared to patients with infarction due to coronary obstruction. Another six studies revealed variable clinical management of these patients. Conclusion: The use of renin-angiotensin-aldosterone system inhibitors should be considered as it is the only medication with proven reduction in mortality. Larger studies are needed to guide with more safety the management of myocardial infarction without coronary obstruction.(AU)

Objetivo: Identificar prácticas clínicas con resultados favorables para pacientes con diagnóstico de infarto agudo de miocardio sin obstrucción arterial coronaria. Método: revisión integrativa de la literatura utilizando las bases de datos de la Biblioteca Nacional de Medicina y la Biblioteca Virtual en Salud de estudios publicados entre 2018 y 2022. Resultados: el 87,5% de los estudios encontrados destacaron estrategias farmacológicas y de estos, el 62,5% citó el uso de la terapia antiplaquetaria dual como el más utilizados, a pesar de que ningún estudio muestra beneficios. Los inhibidores del sistema renina-angiotensina-aldosterona han mostrado beneficios en tres estudios. El 75% de los artículos señalaron que este grupo de pacientes recibe menos medicación preventiva en comparación con los pacientes con infarto por obstrucción coronaria. Otros seis estudios revelaron un manejo clínico variable de estos pacientes. Conclusión: Se debe considerar el uso de inhibidores del sistema renina-angiotensina-aldosterona, ya que es el único medicamento con reducción comprobada de la mortalidad. Son necesarios estudios más amplios que orienten con mayor seguridad el manejo del infarto de miocardio sin obstrucción coronaria.(AU)

Simulação in situ de parada cardíaca em fibrilação ventricular para o treinamento de profissionais de enfermagem / In-situ simulation of cardiac arrest in ventricular fibrillation for professional nursing training

Objetivo: Relatar a experiência e a percepção dos profissionais de enfermagem com a utilização de simulação in situnão anunciada de parada cardiorrespiratória (PCR) em ritmo de fibrilação ventricular no ambiente intra-hospitalar. Métodos: Manequim (Laerdal®) de alta fidelidade foi colocado no leito de isolamento de uma Unidade Coronariana que dispõe de central de monitoramento, sem o conhecimento dos profissionais de enfermagem que estavam assumindo o plantão. Um técnico de enfermagem do turno anterior de trabalho passou o caso como um paciente fictício recém-admitido com infarto agudo do miocárdio. Após a passagem do plantão, modificou-se o ritmo cardíaco do manequim de ritmo sinusal para fibrilação ventricular. Registrou-se o tempo (em minutos e segundos) desde a modificação do ritmo até algum profissional da enfermagem desencadear uma ação efetiva relacionada ao fato. Após o profissional perceber que se tratava de um manequim, ele foi orientado a desencadear as intervenções adequadas como se fosse um paciente real. Após o final da simulação, um questionário para avaliação da percepção desses profissionais em relação à atividade foi aplicado. Resultado: Quinze profissionais participaram da simulação in situ. O tempo para reação foi 28 segundos no turno diurno, dois minutos e seis segundos no turno vespertino e quatro minutos e três segundos no período noturno. Todos profissionais (100%) reconheceram a importância do treinamento, todos (100%) acharam que este treinamento aumenta a segurança do profissional e do paciente, a maioria (90%) achou que pode melhorar a comunicação entre a equipe, e todos (100%) acharam que atividades como esta deveriam ser repetidas. Conclusão: A simulação in situ parece ser uma alternativa viável para o treinamento dos profissionais de enfermagem no atendimento inicial da PCR em um hospital de emergência brasileiro. Esta atividade foi avaliada positivamente pelos participantes (AU).

Objective: Report the experience and perception of nursing professionals with an unannounced in-situ simulation of cardiopulmonary arrest (CPA) in ventricular fibrillation in an in-hospital environment. Methods: A high-fidelity mannequin (Laerdal®) was placed on the isolation bed of a Coronary Care Unit with a monitoring center without the knowledge of the nursing professionals taking over the shift. A nurse technician from the previous shift was told to report the case as a fictitious newly admitted patient with acute myocardial infarction. After the care transition, the cardiac rhythm was changed from sinus rhythm to ventricular fibrillation. The time was recorded (in minutes and seconds) from the onset of ventricular fibrillation until a nursing professional triggered an effective action. After the professionals realized it was a mannequin, they were instructed to initiate the appropriate interventions as if the mannequin were an actual patient. After the end of the simulation, a questionnaire was used to assess the professionals' perception of the activity. Results: Fifteen professionals participated in this in-situ simulation. The reaction time was 28 seconds on the morning shift, two minutes and six seconds on the afternoon shift, and four minutes and three seconds on the night shift. All professionals (100%) recognized the importance of this training, and all thought it increased professional and patient safety. Most participants (90%) thought it could improve communication among the team. All professionals (100%) felt that such activities should be repeated. Conclusion: In-situ simulation is a feasible alternative to train nursing professionals in the initial CPA management in a Brazilian emergency hospital. Participants positively evaluated this activity (AU).

Estudio de caso: revascularización de paciente con enfoque en el proceso de atención de enfermería / Case study: Patient revascularization with focus on the nursing care process

Introducción: la cardiopatía isquémica fue la primera causa de muerte en México en el año 2020. Su prevalencia aumenta con la edad y es superior en los hombres que en las mujeres; se presenta mayormente en forma de infarto en edades entre 45 y 94 años. Objetivo: describir el caso de un paciente sometido a revascularización aorto-coronaria por cardiopatía isquémica con enfoque del proceso de atención de enfermería (PAE). Metodología: estudio de caso observacional y descriptivo con aplicación del PAE en el perioperatorio de un hombre de 50 años con cardiopatía isquémica crónica, enfermedad multivascular e hipertensión sistémica controlada de 6 años desde que inició, en un hospital público de tercer nivel en Mérida, Yucatán, México. Resultados: se demostró que si se aplica el PAE hay menor riesgo de shock hipovolémico ocasionado por sangrado activo y disminución de riesgo de infección del sitio de herida quirúrgica, evidenciado por el procedimiento quirúrgico extenso. Conclusiones: la metodología del PAE como método científico facilita innovaciones dentro de los cuidados enfermeros, además de las diferentes alternativas en las acciones a seguir para el tratamiento del paciente quirúrgico cardiovascular. También proporciona un método informativo para la atención de cuidados, desarrolla una autonomía para la enfermería y fomenta la consideración como profesional de salud.

Introduction: Ischemic heart disease was the leading cause of death in Mexico in 2020. Its prevalence increases with age and it is higher in men than in women; it is presented mostly as a heart attack between the ages of 45 and 94 years. Objective: To describe the case of a patient undergoing aorto-coronary revascularization for ischemic heart disease with a nursing care process (NCP) approach. Methodology: Observational and descriptive case study with application of NCP in the perioperative period of a 50-year-old man with chronic ischemic heart disease, multivessel disease and controlled systemic hypertension of 6 years since its onset, in a third level public hospital in Merida, Yucatan, Mexico. Results: It was demonstrated that by applying NCP there is a lower risk of hypovolemic shock caused by active bleeding and decreased risk of surgical wound site infection, evidenced by the extensive surgical procedure. Conclusions: The NCP methodology as a scientific method facilitates innovations within nursing care, in addition to the different alternatives in the actions to follow for the treatment of the cardiovascular surgical patient. It also provides an informative method for care, develops autonomy for nursing and promotes consideration as a health professional.

Caracterización clinicoepidemiológica, ecocardiográfica y terapéutica de pacientes con infarto agudo de miocardio / Clinical, epidemiological, echocardiographic and therapeutic characterization of patients with acute myocardial infarction i: en

Introducción: Aunque la incidencia general de infarto agudo de miocardio ha disminuido en muchos países desarrollados en las últimas décadas, aún genera números elevados de morbilidad y mortalidad en los de bajos ingresos; mostrando cifras mayores en tiempos de la pandemia por coronavirus. Objetivo: Caracterizar a pacientes con diagnóstico de infarto agudo de miocardio según variables clinicoepidemiológicas, ecocardiográficas y terapéuticas. Métodos: Se realizó una investigación descriptiva y retrospectiva, desde enero de 2018 hasta noviembre de 2022, de 263 pacientes con diagnóstico de infarto agudo de miocardio, atendidos en el Centro de Cardiología y Cirugía Cardiovascular de Santiago de Cuba. Entre las variables analizadas figuraron la edad, el sexo, la topografía del infarto, las complicaciones, las alteraciones ecocardiográficas y el tratamiento trombolítico. Resultados: En la serie predominaron el sexo masculino y el grupo etario menor o igual de 65 años. Se observó una mayor frecuencia del infarto en la topografía inferior (177, para 67,3 %); de estos afectados, 52,1 % tuvo complicaciones. Asimismo, la complicación de mayor frecuencia fue la fibrilación auricular paroxística, seguida del infarto de ventrículo derecho; mientras que la fracción de eyección menor de 45 %, el volumen de la aurícula izquierda y la motilidad parietal presentaron significación estadística. Conclusiones: Las características clinicoepidemiológicas, ecocardiográficas y terapéuticas de los pacientes con infarto agudo de miocardio en la provincia de Santiago de Cuba no difieren del contexto epidemiológico mundial.

Introduction: Although the general incidence of acute myocardial infarction has diminished in many developed countries in the last decades, it still generates high numbers of morbidity and mortality in those with low income; showing higher figures in times of coronavirus. Objective: To characterize patients with diagnosis of acute myocardial infarction according to clinical, epidemiological, echocardiographic and therapeutic variables. Methods: A descriptive and retrospective investigation was carried out from January, 2018 to November, 2022, of 835 patients with diagnosis of acute myocardial infarction, assisted in the Cardiology and Cardiovascular Surgery Center of Santiago de Cuba. Among the analyzed variables there were age, sex, topography of infarction, complications, echocardiographic disorders and thrombolytic treatment. Results: In the series there was a prevalence of the male sex and the 65 or less age group. A higher frequency of infarction in the lower topography (177, for 67.3 %) was observed; of these patients, 52.9 % had complications. Also, the complication of more frequency was the paroxysmal atrial fibrillation, followed by the infarction of the right ventricle; while the ejection fraction smaller than 45 %, the volume of the left auricle and the parietal motility presented statistical significance. Conclusions: Clinical, epidemiological, echocardiographic and therapeutic characteristics of patients with acute myocardial infarction in Santiago de Cuba province do not differ from the world epidemiological context.

Infarto agudo do miocárdio: Tempo é músculo / Acute myocardial infarction: Time is muscle

Objetivo: descrever a impotância de uma detecção precoce do Infarto Agudo do Miocárdio (IAM) por meio da equipe multidisciplinar de saúde e expor se o tempo interfere ou não na piora da lesão miocárdica. Método:Trata-se de uma revisão integrativa da literatura com artigos de 2015 e 2020. As bases utilizadas foram LILACS, MEDLINE, SCIELO, BDEFN e Google Acadêmico. Resulatdos: O tempo porta-balão <90 minutos é eficiente no manejo do paciente com IAM, pois quanto mais rápido atendimento melhor o prognóstico, mas ainda existem muitas dificuldades na realização desse manejo, pois muitos sintomas não são detectados precocemente, a busca pelo atendimento é demorada e as instituições não seguem os protocolos corretamente. Conclusão: Diante deste cenário a telemedicina surge como um aliado no prevenção, diagnóstico e tratamento e principalmente o menor tempo para o atendimento, pois trará mais saúde para o miocárdio e consequentemente para o paciente.(AU)

Objetivo: describir la importancia de la detección precoz del Infarto Agudo de Miocardio (IAM) a través del equipo multidisciplinario de salud y exponer si el tiempo interfiere o no en el empeoramiento de la lesión miocárdica. Método: Se trata de una revisión integrativa de la literatura con artículos de 2015 y 2020. Las bases de datos utilizadas fueron LILACS, MEDLINE, SCIELO, BDEFN y Google Scholar. Resultados: El tiempo puerta-balón < 90 minutos es eficiente en el manejo de los pacientes con IAM, pues cuanto más rápido el tratamiento, mejor el pronóstico, pero aún existen muchas dificultades para realizar este manejo, ya que muchos síntomas no se resuelven. detectada a tiempo, la búsqueda de atención lleva mucho tiempo y las instituciones no siguen correctamente los protocolos. Conclusión: Ante este escenario, la telemedicina surge como un aliado en la prevención, diagnóstico y tratamiento y sobre todo en el menor tiempo de atención, ya que traerá más salud al miocardio y consecuentemente al paciente.(AU)

Objective: to describe the importance of an early detection of Acute Myocardial Infarction (AMI) through the multidisciplinary health team and expose whether or not time interferes in the worsening of the myocardial injury. Method: This is an integrative literature review with articles from 2015 and 2020. The databases used were LILACS, MEDLINE, SCIELO, BDEFN and Google Scholar. Results: The door- to-balloon time <90 minutes is efficient in the management of patients with AMI, because the faster the treatment, the better the prognosis, but there are still many difficulties in carrying out this management, since many symptoms are not detected early, the search for care it is time consuming and institutions do not follow protocols correctly. Conclusion: Given this scenario, telemedicine emerges as an ally in prevention, diagnosis and treatment and especially the shortest time for care, as it will bring more health to the myocardium and consequently to the patient.(AU)

Atendimento a pacientes infartados submetidos à angioplastia antes e durante a COVID-19: estudo transversal / Care of infarcted patients undergoing angioplasty before and during COVID-19: a cross-sectional study

OBJETIVO: Comparar o atendimento de infartados submetidos à angioplastia antes e durante a pandemia da COVID-19. MÉTODO: Pesquisa transversal, de abordagem retrospectiva, com 498 pacientes, por meio de prontuários eletrônicos e físicos, referente a atendimentos antes e durante a pandemia, no serviço de hemodinâmica de hospital de referência para doenças cardiovasculares. Dados analisados por estatística descritiva e inferencial. RESULTADOS: Em 2019, pré-pandemia, realizaram-se 157 procedimentos de intervenção coronária percutânea. Em 2020, início da pandemia, 166 procedimentos, aumento de 5,73%. Em 2021, ocorreram 175 procedimentos, acréscimo de 11,46% em comparação a 2019. CONCLUSÃO: Houve aumento no número de procedimentos de ATC, em 11,46% de 2019 a 2021, com consequente elevação da assistência de enfermagem e multiprofissional durante a pandemia da COVID-19.

OBJECTIVE: To compare the care provided to infarcted patients submitted to angioplasty before and during the COVID-19 pandemic. METHOD: Cross-sectional research, with a retrospective approach, conducted with 498 patients through the assessment of electronic and physical medical records, referring to care provided before and during the pandemic in the hemodynamics clinic of a reference hospital for cardiovascular diseases. Descriptive and inferential statistics were used. RESULTS: In 2019, pre-pandemic period, 157 percutaneous coronary angioplasties were performed. In 2020, at the pandemic's beginning, 166 procedures were performed ­ an increase of 5.73%. In 2021, there were 175 procedures ­an increase of 11.46% compared to 2019. CONCLUSION: There was an increase in percutaneous coronary angioplasties by 11.46% from 2019 to 2021, with a consequent increase in nursing and multidisciplinary care during the COVID-19 pandemic.

Utilidad de la tomografía de coherencia óptica como guía en el tratamiento del síndrome coronario agudo: reporte de un caso / Utility of optical coherence tomography to guide treatment in acute coronary syndromes: case report / Utilidade da tomografia de coerência óptica como guia no tratamento da síndrome coronariana aguda: relato de um caso

La tomografía de coherencia óptica (OCT) es una técnica de imagen endovascular con elevada resolución espacial que permite evaluar las diferentes estructuras que componen la pared de las arterias coronarias, caracterizar morfológicamente la placa aterosclerótica y establecer el mecanismo fisiopatológico subyacente en los síndromes coronarios agudos (SCA). Se presenta el caso clínico de un paciente con infarto agudo de miocardio, donde la OCT evidenció que la reducción de la luz arterial estaba determinada principalmente por la presencia de trombo, a la vez que demostró una disrupción endotelial (ruptura de placa) como mecanismo fisiopatológico subyacente. Se adoptó una estrategia invasivo-conservadora, donde finalmente no se implantó stent. La información surgida de la OCT en este caso particular fue fundamental en la toma de decisiones.

Optical coherence tomography (OCT) is an endovascular imaging technique with high spatial resolution. It allows to evaluate the different structures that compose coronary arteries' wall, morphologically characterize atherosclerotic plaques and establish the underlying pathophysiological mechanism in acute coronary syndromes (ACS). The case of a patient with acute myocardial infarction is presented, in which OCT showed that the reduction of arterial lumen was determined mainly by the presence of thrombus, while also demonstrated endothelial disruption (plaque rupture) as the underlying pathophysiological mechanism. An invasive-conservative strategy was adopted and finally stent was not implanted. The information that emerged from the OCT in this particular case was fundamental in decision-making.

A tomografia de coerência óptica (OCT) é uma técnica de imagem endovascular com alta resolução espacial que permite a avaliação das diferentes estruturas que compõem a parede das artérias coronárias, a caracterização morfológica da placa aterosclerótica e o estabelecimento do mecanismo fisiopatológico subjacente de síndrome coronariana aguda (SCA). Apresentamos o caso clínico de um paciente com enfarte agudo do miocárdio, onde a OCT mostrou que a redução do lúmen arterial foi determinada principalmente pela presença de trombo, ao mesmo tempo que demonstrou uma ruptura endotelial (ruptura da placa) como causa fisiopatológica subjacente. Adotou-se uma estratégia invasiva-conservadora, onde finalmente o stent não foi implantado. As informações obtidas da OCT neste caso específico foram fundamentais na tomada de decisão.

Clinical significance of LncRNA-MIAT as a non-invasive diagnostic marker of nonHodgkin's lymphoma associated with occult hepatitis C virus infection

Aims: the current research aimed to investigate LncRNA-MIAT in patients with nonHodgkin lymphoma (NHL) and to assess its correlation with clinicopathological features and treatment protocols of NHLs among Egyptian patients with Occult hepatitis C virus (HCV) infection (OCI). Patients & Methods: This study was conducted on 20 patients with NHL and 30 healthy subjects as the control group. All subjects were screened for HCV-RNA in both plasma and PBMCs. RT-PCR determined lncRNA-MIAT. Results: lncRNA-MIAT relative expression level was upregulated in NHL groups (2.73±0.86) compared to controls (1.06±0.07), P ˂0.001*. Among NHL, patients with OCI (3.2±0.63) had significantly higher levels of lncRNA-MIAT compared to HCV (2.6±1.08) and non-HCV (2.4±0.4), P ˂0.001*. Additionally, the relative expression levels of lncRNA-MIAT were significantly positively correlated with laboratory and clinicopathological features of NHL. Interestingly, concerning the treatment of DLBCLNHL, there were significantly higher levels of lncRNA-MIAT in no treatment subgroup (n=10, 3.31±0.95) compared to successfully treated subgroups [CHOP (n=7, 1.58±0.34) and R-CHOP (n=3, 11.16±0.21), P ˂0.001* Conclusions: lncRNA-MIAT level was upregulated in NHL patients, particularly patients with OCI. Thus, circulatory lncRNA-MIAT may serve as a promising non-invasive diagnostic marker for NHL associated with OCI

Effect of co-morbid chronic kidney disease on the accuracy of cardiac troponin levels for diagnosis of acute myocardial infarction / 南方医科大学学报

OBJECTIVE@#To evaluate the accuracy of cardiac troponin (cTn) levels in the diagnosis of acute myocardial infarction (AMI) in patients with chronic kidney disease (CKD) and explore a potential strategy for improving the diagnostic accuracy.@*METHODS@#We retrospectively analyzed the data from patients with high-risk chest pain admitted in Zhujiang Hospital from January, 2018 to December, 2020, including 126 patients with and 272 patients without CKD, and 122 patients diagnosed to have AMI and 276 patients without AMI. The baseline clinical data of the patients and blood test results within 12 h after admission were collected.@*RESULTS@#In patients without AMI, cTnT level was significantly higher in those with co-morbid CKD than in those without CKD (P < 0.001), and showed a moderate negative correlation with eGFR (rs=- 0.501, P < 0.001), while cTnI level did not differ significantly between the two groups (P=0.72). In patients with CKD, the optimal cutoff level was 0.177 μg/L for cTnT and 0.415 ng/mL for cTnI for diagnosis of AMI, for which cTnI had a higher specificity than cTnT. The diagnostic model combining both cTnT and cTnI levels [P=eY/(1+ eY), Y=6.928 (cTnT)-0.5 (cTnI)-1.491] had a higher AUC value than cTn level alone.@*CONCLUSION@#In CKD patients, the cutoff level of cTn is increased for diagnosing AMI, and cTnI has a higher diagnostic specificity than cTnT. The combination of cTnT and cTnI levels may further improve diagnostic efficacy for AMI.

Exploring the Feasibility of Machine Learning to Predict Risk Stratification Within 3 Months in Chest Pain Patients with Suspected NSTE-ACS / 生物医学与环境科学（英文）

OBJECTIVE@#We aimed to assess the feasibility and superiority of machine learning (ML) methods to predict the risk of Major Adverse Cardiovascular Events (MACEs) in chest pain patients with NSTE-ACS.@*METHODS@#Enrolled chest pain patients were from two centers, Beijing Anzhen Emergency Chest Pain Center Beijing Bo'ai Hospital, China Rehabilitation Research Center. Five classifiers were used to develop ML models. Accuracy, Precision, Recall, F-Measure and AUC were used to assess the model performance and prediction effect compared with HEART risk scoring system. Ultimately, ML model constructed by Naïve Bayes was employed to predict the occurrence of MACEs.@*RESULTS@#According to learning metrics, ML models constructed by different classifiers were superior over HEART (History, ECG, Age, Risk factors, & Troponin) scoring system when predicting acute myocardial infarction (AMI) and all-cause death. However, according to ROC curves and AUC, ML model constructed by different classifiers performed better than HEART scoring system only in prediction for AMI. Among the five ML algorithms, Linear support vector machine (SVC), Naïve Bayes and Logistic regression classifiers stood out with all Accuracy, Precision, Recall and F-Measure from 0.8 to 1.0 for predicting any event, AMI, revascularization and all-cause death ( vs. HEART ≤ 0.78), with AUC from 0.88 to 0.98 for predicting any event, AMI and revascularization ( vs. HEART ≤ 0.85). ML model developed by Naïve Bayes predicted that suspected acute coronary syndrome (ACS), abnormal electrocardiogram (ECG), elevated hs-cTn I, sex and smoking were risk factors of MACEs.@*CONCLUSION@#Compared with HEART risk scoring system, the superiority of ML method was demonstrated when employing Linear SVC classifier, Naïve Bayes and Logistic. ML method could be a promising method to predict MACEs in chest pain patients with NSTE-ACS.

Impact of Smoke-Free Legislation on Acute Myocardial Infarction and Subtypes of Stroke Incidence in Shenzhen, China, 2012-2016: An Interrupted Time Series Analysis / 生物医学与环境科学（英文）

OBJECTIVE@#This study assesses the impact of smoke-free legislation on the incidence rate for acute myocardial infarction (AMI) and stroke in Shenzhen.@*METHODS@#Data on ischemic ( n = 72,945) and hemorrhagic ( n = 18,659) stroke and AMI ( n = 17,431) incidence covering about 12 million people in Shenzhen from 2012 to 2016 were used. Immediate and gradual changes in incidence rates were analyzed using segmented Poisson regression.@*RESULTS@#Following the smoke-free legislation, a 9% (95% CI: 3%-15%) immediate reduction was observed in AMI incidence, especially in men (8%, 95% CI: 1%-14%) and in those aged 65 years and older (17%, 95% CI: 9%-25%). The gradual annual benefits were observed only in hemorrhagic and ischemic stroke incidence, with a 7% (95% CI: 2%-11%) and 6% (95% CI: 4%-8%) decrease per year, respectively. This health effect extended gradually to the 50-64 age group. In addition, neither the immediate nor gradual decrease in stroke and AMI incidence rates did not show statistical significance among the 35-49 age group ( P > 0.05).@*CONCLUSION@#Smoke-free legislation was enforced well in Shenzhen, which would generate good experiences for other cities to enact and enforce smoke-free laws. This study also provided more evidence of the health benefits of smoke-free laws on stroke and AMI.

Anticoagulation status and adherence in patients with atrial fibrillation hospitalized for ACS and the impact on 1-year prognosis: a multicenter cohort study / 中华心血管病杂志

Objective: For patients with atrial fibrillation (AF) complicated with acute coronary syndrome (ACS), both anticoagulant and antiplatelet therapy should be applied, but the use of anticoagulation therapy is still poor in these patients in China. The purpose of this study was to explore the status and adherence of antithrombotic therapy in AF patients with ACS and the impact on 1 year clinical outcomes. Methods: Patients with AF hospitalized for ACS were retrospectively included from 6 tertiary hospitals in China between July 2015 and December 2020. According to the use of anticoagulant drugs at discharge, patients were divided into two groups: anticoagulant treatment group and non-anticoagulant treatment group. Logistic regression model was used to analyze the main factors influencing the use of anticoagulant drugs in patients with atrial fibrillation complicated with ACS. Major adverse cardiac events (MACEs) were defined as all-cause death, non-fatal myocardial infarction or coronary revascularization, and ischemic stroke and Bleeding Academic Research Consortium (BARC) 3 bleeding events were also collected at 1 year after discharge. After propensity score matching, Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the effect of anticoagulant treatment and non-anticoagulant treatment on 1-year prognosis. The patients were divided into different groups according to whether anticoagulation was performed at discharge and follow-up, and the sensitivity of the results was analyzed. Results: A total of 664 patients were enrolled, and 273 (41.1%) were treated with anticoagulant therapy, of whom 84 (30.8%) received triple antithrombotic therapy, 91 (33.3%) received double antithrombotic therapy (single antiplatelet combined with anticoagulant), and 98 (35.9%) received single anticoagulant therapy. Three hundred and ninety-one (58.9%) patients were treated with antiplatelet therapy, including 253 (64.7%) with dual antiplatelet therapy and 138 (35.3%) with single antiplatelet therapy. After 1∶1 propensity score matching between the anticoagulant group and the non-anticoagulant group, a total of 218 pairs were matched. Multivariate logistic regression analysis showed that history of diabetes, HAS-BLED score≥3, and percutaneous coronary intervention were predictors of the absence of anticoagulant therapy, while history of ischemic stroke and persistent atrial fibrillation were predictors of anticoagulant therapy. At 1-year follow-up, 218 patients (79.9%) in the anticoagulant group continued to receive anticoagulant therapy, and 333 patients (85.2%) in the antiplatelet group continued to receive antiplatelet therapy. At 1-year follow-up, 36 MACEs events (13.2%) occurred in the anticoagulant group, and 81 MACEs events (20.7%) in the non-anticoagulant group. HR values and confidence intervals were calculated by Cox proportional risk model. Patients in the non-anticoagulant group faced a higher risk of MACEs (HR=1.802, 95%CI 1.112-2.921, P=0.017), and the risk of bleeding events was similar between the two group (HR=0.825,95%CI 0.397-1.715, P=0.607). Conclusions: History of diabetes, HAS-BLED score≥3, and percutaneous coronary intervention are independent factors for the absence of anticoagulant therapy in patients with AF complicated with ACS. The incidence of MACEs, death and myocardial infarction is lower in the anticoagulant group, and the incidence of bleeding events is similar between the two groups. The risk of bleeding and ischemia/thrombosis should be dynamically assessed during follow-up and antithrombotic regiments should be adjusted accordingly.

The impact of LDL-C/HDL-C ratio on severity of coronary artery disease and 2-year outcome in patients with premature coronary heart disease: results of a prospective, multicenter, observational cohort study / 中华心血管病杂志

Objective: To explore the relationship between low density lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) ratio with the severity of coronary artery disease and 2-yeat outcome in patients with premature coronary heart disease. Methods: This prospective, multicenter, observational cohort study is originated from the PROMISE study. Eighteen thousand seven hundred and one patients with coronary heart disease (CHD) were screened from January 2015 to May 2019. Three thousand eight hundred and sixty-one patients with premature CHD were enrolled in the current study. According to the median LDL-C/HDL-C ratio (2.4), the patients were divided into two groups: low LDL-C/HDL-C group (LDL-C/HDL-C≤2.4, n=1 867) and high LDL-C/HDL-C group (LDL-C/HDL-C>2.4, n=1 994). Baseline data and 2-year major adverse cardiovascular and cerebrovascular events (MACCE) were collected and analyzed in order to find the differences between premature CHD patients at different LDL-C/HDL-C levels, and explore the correlation between LDL-C/HDL-C ratio with the severity of coronary artery disease and MACCE. Results: The average age of the low LDL-C/HDL-C ratio group was (48.5±6.5) years, 1 154 patients were males (61.8%); the average age of high LDL-C/HDL-C ratio group was (46.5±6.8) years, 1 523 were males (76.4%). The number of target lesions, the number of coronary artery lesions, the preoperative SNYTAX score and the proportion of three-vessel coronary artery disease in the high LDL-C/HDL-C group were significantly higher than those in the low LDL-C/HDL-C group (1.04±0.74 vs. 0.97±0.80, P=0.002; 2.04±0.84 vs. 1.85±0.84, P<0.001; 13.81±8.87 vs. 11.70±8.05, P<0.001; 36.2% vs. 27.4%, respectively, P<0.001). Correlation analysis showed that there was a significant positive correlation between LDL-C/HDL-C ratio and preoperative SYNTAX score, the number of coronary artery lesions, the number of target lesions and whether it was a three-vessel coronary artery disease (all P<0.05). The 2-year follow-up results showed that the incidence of MACCE was significantly higher in the high LDL-C/HDL-C group than that in the low LDL-C/HDL-C group (6.9% vs. 9.1%, P=0.011). There was no significant difference in the incidence of all-cause death, cardiac death, myocardial infarction, stroke, revascularization and bleeding between the two groups. Cox multivariate regression analysis showed that the LDL-C/HDL-C ratio has no correlation with 2-year MACCE, death, myocardial infarction, revascularization, stroke and bleeding events above BARC2 in patients with premature CHD. Conclusion: High LDL-C/HDL-C ratio is positively correlated with the severity of coronary artery disease in patients with premature CHD. The incidence of MACCE of patients with high LDL-C/HDL-C ratio is significantly higher during 2 years follow-up; LDL-C/HDL-C ratio may be an indicator for evaluating the severity of coronary artery disease and long-term prognosis in patients with premature CHD.