Changes in process and outcome for ST elevation myocardial infarction in central China from 2011 to 2018 / 中华医学杂志(英文版)

BACKGROUND@#Limited data are available on the changes in the quality of care for ST elevation myocardial infarction (STEMI) during China's health system reform from 2009 to 2020. This study aimed to assess the changes in care processes and outcome for STEMI patients in Henan province of central China between 2011 and 2018.@*METHODS@#We compared the data from the Henan STEMI survey conducted in 2011-2012 ( n = 1548, a cross-sectional study) and the Henan STEMI registry in 2016-2018 ( n = 4748, a multicenter, prospective observational study). Changes in care processes and in-hospital mortality were determined. Process of care measures included reperfusion therapies, aspirin, P2Y12 antagonists, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins. Therapy use was analyzed among patients who were considered ideal candidates for treatment.@*RESULTS@#STEMI patients in 2016-2018 were younger (median age: 63.1 vs . 63.8 years) with a lower proportion of women (24.4% [1156/4748] vs . 28.2% [437/1548]) than in 2011-2012. The composite use rate for guideline-recommended treatments increased significantly from 2011 to 2018 (60.9% [5424/8901] vs . 82.7% [22,439/27,129], P <0.001). The proportion of patients treated by reperfusion within 12 h increased from 44.1% (546/1237) to 78.4% (2698/3440) ( P <0.001) with a prolonged median onset-to-first medical contact time (from 144 min to 210 min, P <0.001). The use of antiplatelet agents, statins, and β-blockers increased significantly. The risk of in-hospital mortality significantly decreased over time (6.1% [95/1548] vs . 4.2% [198/4748], odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.50-0.88, P = 0.005) after adjustment.@*CONCLUSIONS@#Gradual implementation of the guideline-recommended treatments in STEMI patients from 2011 to 2018 has been associated with decreased in-hospital mortality. However, gaps persist between clinical practice and guideline recommendation. Public awareness, reperfusion strategies, and construction of chest pain centers need to be further underscored in central China.

Effect of collaborative work pattern of doctors and nurses on acute myocardial infarction patients with percutaneous coronary intervention after one year follow up / 中国实用护理杂志

Objective To explore the management model of chronic disease like myocardial infarction through the effect of collaborative work pattern of doctors and nurses on acute myocardial infarction patients with percutaneous coronary intervention(PCI) after 1 year follow up.Methods A total of 852 patients from October 1,2011 to September 30,2013 with collaborative work pattern of doctors and nurses were as collaborative work pattern group,and 734 patients without collaborative work pattern of doctors and nurses at the same time were as control group.The patients were followed up for 1 year.The differences of treatment compliance,risk factors control,and the incidence of cardiovasc~ar events were compared between collaborative work pattern group and control group.Results The improvement of treatment compliance in collaborative work pattern group was better than that in control group.The improvement rate of improve lifestyle initiatively,completely medication,check regularly were 83.3％(710/852),97.9％(834/852),75.4％(642/852) in collaborative work pattern group and 63.5％(466/734),93.7％(688/734),59.0％(433/734) in control group,x2=81.02,17.57,26.22,P＜0.01.The control rate of risk factors including hypertension,diabetic mellitus,high blood low density lipoprotein cholesterol were 78.5％ (252/321),68.4％ (214/313),84.8％ (491/579) in collaborative work pattern group and 55.8％ (168/301),58.1％ (168/289),79.9％ (381/477) in control group,x2=36.47,6.79,4.41,P＜0.01 or ＜0.05.The incidence of treatment compliance and total cardiovascular events in collaborative work pattern group were better than those in control group.There were significant differences in the above indices,P＜0.05.Conclusions Collaborative work pattern of doctors and nurses is an effective method and supplement for patients with myocardial infarction after PCI to improve treatment compliance and control risk factors.The prognosis of patients can be improved and this pattern is an effective exploration of chronic disease management.

Analysis of auxiliary effect of oxalic acid Ai Sciplan auxiliary effect assisted with psychological intervention on coronary heart disease complicated with depression / 天津医药

Objective To investigate the curative effects of oxalic acid Ai Sciplan in assisting psychological therapy for coronary heart disease accompanied with depression. Methods A total of 136 patients of coronary heart disease with de?pression were randomly divided into control group and treatment group. The routine drug treatment was given to control group. Treatment group was given oxalic acid Ai Sciplan which is assisted by the psychological therapy based on the routine drug treatment schedule for six months. HAMD score before treatment, one-week, one-month, 3-month and 6-month after treatment were compared between two groups. Homocysteine (Hcy) and high sensitive C reactive protein (hs-CRP) levels were detected by circulating enzymatic method before treatment and 6-month after treatment. The WHO quality of life scale (WHOQOL-BREF) was used to assess the quality of life in two groups of patients. The improvements of angina and depressive symptoms were evaluated after 6-month treatment. The cardiovascular events were followed up in two groups. Re?sults HAMD scores significantly decreased after treatment in both groups (P < 0.05). HAMD scores at all different time points were significantly lower after treatment than those before treatment in treatment group. In control group, HAMD scores at different time points were also significantly lower after treatment than those before treatment, except time point of one week after treatment. The levels of Hcy and hs-CRP were decreased after treatment in two groups, and the levels were lower in treatment group than those of control group. Values of WHOQOL-BREF score, mental status, social relations and the sur?rounding environment scores were higher after treatment in both groups. Also they are higher in treatment group than that of control group. The angina and depressive symptoms were improved in treatment group. The incidences of angina, myocardial infarction, arrhythmia, heart failure, sudden cardiac death and other cardiovascular events were significantly lower in treat?ment group than those of control group (χ2=9.396, P<0.05). Conclusion Escitalopram oxalate combined with psychological therapy shows a significant beneficial effect and a better prognosis in the treatment of coronary heart disease and depression.

Effect of Smoking on Clinical Prognosis in Male Patients With Acute Coronary Syndrome After Drug-eluting Stent Therapy / 中国循环杂志

Objective: To investigate the compliance of smoking cessation and the effect of smoking status on long-term clinical prognosis in male patients with acute coronary syndrome (ACS) after drug-eluting stent (DES) therapy. Methods: A total of 656 ACS patients after DES therapy were studied, according to the post-operative smoking status, the patients were divided into 3 groups: Non-smoking group,n=226, Quit smoking group,n=283 and Persistent smoking group, n=147. The patients were followed-up for the average of 27 months, the major adverse cardio-/cerebral-vascular events (MACCE) were recorded in detail, and the effect of smoking status for MACCE occurrence were evaluated by multivariable Cox regression analysis. Results: The pre-operative smoking rate was 65.5% (430/656) of patients and post-operative smoking rate was 22.4% (147/656). Compared with Non-smoking group and Quit smoking group, the patients in Persistent smoking group had the younger age (P<0.001), more patients with abnormal blood lipids (P=0.005) and having lower level of education (P<0.001). The all cause death rates in Non-smoking group, Quit smoking group and Persistent smoking group were at 1.8%, 1.1% and 6.1% respectively,P=0.004; the MACCE occurrence rates were at 7.1%, 5.3% and 15.0% respectively,P=0.002. Multivariable Cox regression analysis showed that post-operative smoking was the independent risk factor for MACCE occurrence, HR =1.404, 95% CI (1.206-1.793),P=0.008. Conclusion: Smoking is the independent risk factor for MACCE occurrence in male ACS patients after DES therapy.

Effects of low T3 level on the severity of coronary artery lesions and prognosis / 实用医学杂志

Objective To analyze the severity of coronary artery lesions and the prognosis in patients with low levels of free triiodothyronine (fT3)undergoing coronary angiography (CAG). Methods From August 2011 to August 2012, 600 consecutive suspected patients with coronary heart disease (CHD) who undergone CAG were selected. The patients were divided into two groups based on thyroid function prior to CAG:euthyroidism group (450 patients) and low T3 group (150 patients). All the patients underwent elective coronary angiography, then the severity of coronary artery lesions was assessed by the Gensini scores , and the patients were followed up for cardiovascular events. Results The incidence rate of CHD in low T3 group was significantly higher than that in euthyroidism group (P=0.01). Multiple variables logistic regression analysis showed that fT3 was a protective factor for CHD (OR = 0.351,P < 0.001); The severity of coronary artery lesions was greater in low T3 group than in euthyroidism group (P < 0.001). The mean duration of follow-up was (15.4 ± 3.6) months; the incidence of the composite end-point (death, non-fatal myocardial infarction and target vessel revascularization ) was significantly higher in low T3 group than in euthyroidism group (P=0.023). Conclusions Patients with a decreased T3 level has a higher incidence rate of CHD , an increase in the severity of coronary artery lesions , and a poorer prognosis.

Relationship of serum free T3 with the coronary artery calcification and major adverse cardiac events in patients with suspected coronary artery disease / 中华心血管病杂志

<p><b>OBJECTIVE</b>To survey the association of serum free triiodothyronine (FT3) level with coronary artery calcification and major adverse cardiac events (MACE) in outpatients with suspected coronary artery disease (CAD).</p><p><b>METHODS</b>A total of 577 outpatients with suspected CAD, who underwent dual-source computed tomography and FT3 detection were included, patients were followed up for 8-29 months for the major adverse cardiac events (death, MI, PCI, CABG). These patients were divided into low FT3 ( < 3.5 pmol/L, n = 126) and normal FT3 ( ≥ 3.5 pmol/L, n = 451) group based on the FT3 level, and divided into CACS > 100 (n = 235) and CACS ≤ 100 (n = 342) group based on the coronary artery calcium score (CACS). Related factors to CACS and MACE were analyzed using logistic regression (stepwise) analysis.</p><p><b>RESULTS</b>CACS (146.7 (55.8, 599.1) vs. 34.8 (0, 261.9), P < 0.001) and MACE (7.9% (10/126) vs. 2.0% (9/451) , P = 0.003) were significantly higher in the low FT3 group than in normal FT3 group. Logistic regression analysis demonstrated that the FT3 levels are inversely associated with the CACS (OR = 0.442, 95%CI = 0.317-0.618, P < 0.001). Kaplan-Meier analysis displayed that patients with low FT3 levels had a lower cumulative survival rate than patients with normal FT3 levels (P = 0.005), and patients with CACS > 100 also had a lower cumulative survival rate than patients with CACS ≤ 100(P < 0.001).</p><p><b>CONCLUSIONS</b>FT3 levels are associated with coronary artery calcification scores and the incidence rate of MACE in patients with suspected coronary artery disease. A low FT3 level is considered as an important risk factor of high calcification scores and MACE.</p>

Instrution of risk stratification according to BNP concentration for exercise rehabilitation nursing in young and middle myocardial infarction patients / 中国实用护理杂志

Objective To investigate whether BNP(brain natriuretic peptide) could be relatively objective index for comprehensive risk stratification of exercise rehabilitation nursing in young and middle myocardial infarction patients. Methods BNP concentration and LVEF were measured respctively in young and middle myocardial infarction patients. Then the risk stratification was administrated based these index respectively and Barther Scores and significant statistical differences were calculated according to homogeneity test for variance. Results Blood BNP concentrations in acute phase among the divided group based on EF risk stratification were significant difference,hence the standard deviation is large,which led to variance nonhomogeneity,and stracification difference between groups is not clear and across-talking. Exercise rehabilitation nursing scores based on echocardiography EF value had significant difference even veariance is nonhomogeneity,hence the differ-ence is not clear beween groups.Exercise rehabilitation nursing scores based on BNP was administrated and significance is clear beween groups. Conclusions BNP concentration and LVEF value had certain relationship and cross-talking among them.Risk stratification based on BNP concentration had objective instructions for exercise rehabili tation nursing in actue infarction myocardial pa-tients.

Effect evaluation of autologous bone marrow monuclear cell transplantation for the treatment of chronic heart failure / 中国组织工程研究

BACKGROUND: Both therapeutic effects of stem cell transplantation and differentiation mechanism remain controversial;however, plentiful clinical studies have indicated that stem call transplantation might improve heart function.OBJECTIVE: To evaluate the efficacy of intracoronary autologous bone marrow mononuclear call transplantation for the treatment of chronic heart failure.DESIGN: Case analysis. PARTICIPANTS: A total of 80 patients with chronic heart failure who were selected from Henan People's Hospital from 2003 to 2008 were divided into two groups: autologous bone marrow mononuclear call transplantation group (n=48) and conventional drug therapy group (n=32). There were no significant differences in sex, age, accepting conventional drug therapy,echocardiogram before transplantation, plasma brain natriuretic peptide level, and myocardial perfusion imaging between the two goups (P>0.05).METHODS: A one-year following up before and after cell transplantation, conventional drug therapy was performed in the two groups. Based on conventional drug therapy, autologous bone marrow mononuclear call suspension (10 mL) was slowly poured into coronary artery, and the cell number was adjusted to (3.1±1.6)×10 8. MAIN OUTCOME MEASURES: Changes of heart function were measured using ultrasound apparatus; plasma brain natriuretic peptide levels were detected using double antibodies immumofluorescence method; area of myocardial perfusion defect region was detected using single photon emission computed tomography.RESULTS: Patients in the two groups finished the one-year follow-up, and adverse effects and complications were not found before and after cell transplantation. ①Compared to before cell transplantation, end-systolic volume (ESV) of the left ventricle was significantly decreased in the autologous bone marrow mononuclear cell transplantation group after one year (P < 0.05), but ejection fraction (EF) of the left ventricle was significantly increased (P < 0.05). However, both ESV and EF were not changed in the conventional drug therapy group (P> 0.05). Compared to conventional drug therapy group, ESV and EF were changed significantly in the autologous bone marrow mononuclear call transplantation group after one year (P < 0.05). ②Compared to before cell transplantation, plasma brain natriuretic peptide levels were significantly decreased in the two groups (P < 0.05 or 0.01). Area of myocardial perfusion defect region was significantly decreased (P < 0.05 or 0.01), and the area change in the autologous bone marrow mononuclear call transplantation group was significantly greater than conventional drug therapy group (P < 0.05).CONCLUSION: Autologous bone marrow mononucleer call transplantation is safe and feasible for the treatment of chronic heart failure, and it also can remarkably improve heart function and myocardial perfusion within one year.

Analysis and analyzing mechanisms of HERG channel kinetics / 生物医学工程学杂志

We have investigated the methods and mechanisms for analysis of the channel kinetics parameters of voltage-gated potassium channels, HERG (Human ether-à-go-go related gene) channels, in the process of electrophysiological recording. The current of HERG K+ channels expressed in Xenopus oocytes was studied using a two-electrode voltage clamp technique, and the channel kinetics parameters were analyzed through compiling different pulse protocol and recording the current. Results showed: (1) The HERG K+ channels, under conditions of being activated with depolarized pulse, expressed an inward-rectified property attributing to rapid inactivation. The activation curve could be obtained through fitting the depolarized potential and the following peak amplitude of tail current, while the parameters of time-dependent activation was obtained through fitting different depolarized duration and the corresponding peak amplitude of tail current. (2) The I-V relationship still exhibit marked inward rectification. Tail current decay traces were fitted with a bi-exponential function to determine the time constants of the fast and slow components of current decay. (3) The inactivation of HERG channels is voltage-dependent. The inactivation process was isolated with two different three-pulse protocols, with which the inactivation curve and nearly linear I-V relationship were obtained, respectively. Thus, altough the kinetics properties of HERG channels were complicated, the channels kinetics could be indirectly analyzed through differently designed pulse protocols, which provided the basis for investigation on Alanine-scanning mutagenesis and agent action.

Psychological stress increases expression of aortic plaque intercellular adhesion molecule-1 and serum inflammatory cytokines in atherosclerotic rabbit model / 老年心脏病学杂志（英文版）

Plaque rupture,platelet aggregation,and thrombogenesis are the main mechanisms of acute coronary syndrome (ACS),and inflammation factors play key roles in plaque unstability.Psychological stress promotes acute inflammatory response,leading to increased circulating levels of C-reactive protein (CRP),IL-6,and serum intercellular adhesion molecule (sICAM)-1.But it is not clear that whether psychological stress has a direct effect on atherosclerotic plaque stability.The purpose of this study was to investigate effects of chronic psychological stress on inflammatory marker (ICAM-1 ) in atherosclerotic plaque,and inflammatory markers in peripheral blood.Materials and methods Sixty male rabbits were randomized into 2 groups:the control group (n =10) and the atherosclerotic group (n =50).The latter were fed on high fatty diet and were given a large dose of vitamin D3 (3 600 000IU/kg) via intraperitoneal injection.After 8 weeks,the atherosclerotic model was estaslished.Then the 50 atherosclerotic model rabbits were divided into 3 subgroups:no-stress subgroup (n = 16),physiological stress subgroup (n = 16) and psychological stress subgroup (n =18).In physiological stress subgroup and psychological stress subgroup,drinking was cut from twice a day to once a day.At the same time,psychological stress subgroup was given empty bottle stress,and this process lasted for 2 weeks.One hour after the last stress,the blood samples were collected and the serum levels of CRP,IL-6 amd ICAM-1 were tested by radioimmunoassay or enzyme linked immunosorbent assay.The aorta and heart were extracted for pathology examination,and the express of ICAM-1 was tested by immunohistochemical examination.Results (1) After effective atherosclerotic animal model construction,the expression of ICAM-1 in aorta was higher in atherosclerotic group than that in control group (P＜0.01),and was notably higher in psychological stress subgroup than that in no-stress subgroup or in physiological stress subgroup (2.18±0.17 vs 1.58±0.22,1.22±0.15,P＜0.001,respectively).The expression in physiological stress subgroup was higher than that in no-stress subgroup (584±0.22 vs 1.22±0.15,P=0.001).(2) The serum level of IL-6 (51.80±4.60 pg/ml vs 27.60±4.19 pg/ml,8.01±1.39 pg/ml,7.83±1.37 pg/ml),sICAM-1 ( 1.24±0.25 vs 0.85±0.09,0.62±0.17,0.57±0.11),CRP ( 1.004±0.37 vs 0.90±0.29,1.01±0.22,0.71±0.13) in psychological stress group were significantly higher than that in other groups (All P＜0.05).There was a positive relationship between the serum level of CRP,IL-6 and ICAM-1 and the expression of ICAM-1 in aorta wall ( r =0.59,r =0.75,r =0.87,P＜0.01,respectively).Conclusions Psychological stress induces an increased expression of ICAM-1 in aortic atherosclerotic plaque,a higher serum level of CRP,IL-6,and sICAM-1 expression.Psychologial stress has a direct effect on the transition from stability to unstability through in-plaque and out-plaque inflammation.The serum level of CRP,IL-6 and ICAM-1 can reflex the inflammatory degree in atherosclerotic plaque.(J Geriatr Cardiol 2008;5:235-242)

Therapeutic effect observing of autologous bone marrow mononuclear cell transplantation on the patients with chronic heart failure / 中国医师进修杂志

Objective To evaluate the efficacy of intracoronary,antologous bone marrow mononuclear cell transplantation on the patients with chronic heart failure.Methods Eighty patients with chronic heart failure were assigned into bone marrow cell transplantation group (n=48) and control group (n=32),with intmcomnary delivery of autologous bone marrow mononuclear cell suspension or not respectively,in addifion to conventional treatment.The left venlrieular ejection fractions (LVEF),the level of plasma brain natriuretic peptide (BNP),and the siges of myocardial perfusion defect were measured and compared with useing single photom emission computed tomography (SPECT) and echocardiography before and after the treatment.Results The one year follow-up results showed that LVEF increased from base-line (42.1±5.8)%,(43.9±6.7)% to (54.1±4.8)%,(49.8±7.7)% by echocardiography.The plasma levels of BNP decreased from base-line (699±101)ng/L,(687±95)ng/L to (305±78)ng/L,(399±89)ng/L,and the size of myocardial perfusion defect decreased from bese-line (26.8±8.6)%,(26.3±6.5)% to (15.8±4.3)%,(20.5±7.8)% in bone marrow cell transplantation group and control group respectively,the absolute changes were statistically significant.During and after the procedure of bone marrow cell transplantation group,there was no complication occurring. Conclusion Intmcoronary autologous bone marrow mononuclear cell transplantation for treating patients with chronic heart failure results in improvement in left ventricular systolic function and myocardial perfusion,and this therapy is safe and feasible.