Relationship between High Level of Estimated Glomerular Filtration Rate and Contrast-Induced Acute Kidney Injury in Patients who Underwent an Emergency Percutaneous Coronary Intervention / 中华医学杂志(英文版)

Background@#Mounts of studies have shown that low estimated glomerular filtration rate (eGFR) is associated with increased risk of adverse outcomes in patients with coronary artery disease. However, high level of eGFR was less reported. In the study, we aimed to explore the relationship between the baseline eGFR, especially the high level, and contrast-induced acute kidney injury (CI-AKI) in a Chinese population who underwent an emergency percutaneous coronary intervention (PCI).@*Methods@#Patients who underwent an emergency PCI from 2013 to 2015 were enrolled and divided into five groups as eGFR decreasing. Baseline characteristics were collected and analyzed. The rates of CI-AKI and the composite endpoint (including nonfatal myocardial infarction, revascularization, stroke, and all-cause death) at 6- and 12-month follow-up were compared. Logistic analysis for CI-AKI was performed.@*Results@#A total of 1061 patients were included and the overall CI-AKI rate was 22.7% (241/1061). The separate rates were 77.8% (7/9) in Group 1 (eGFR ≥120 ml·min·1.73 m), 26.0% (118/454) in Group 2 (120 ml·min·1.73 m> eGFR ≥90 ml·min·1.73m), 18.3% (86/469) in Group 3 (90 ml·min·1.73 m> eGFR ≥60 ml·min·1.73 m), 21.8% (26/119) in Group 4 (60 ml·min·1.73 m> eGFR ≥30 ml·min·1.73 m), and 40.0% (4/10) in Group 5 (eGFR <30 ml·min·1.73 m), with statistical significance (χ = 25.19, P < 0.001). The rates of CI-AKI in five groups were 77.8%, 26.0%, 18.3%, 21.8%, and 40.0%, respectively, showing a U-typed curve as eGFR decreasing (the higher the level of eGFR, the higher the CI-AKI occurrence in case of eGFR ≥60 ml·min·1.73 m). The composite endpoint rates in five groups were 0, 0.9%, 2.1%, 6.7%, and 0 at 6-month follow-up, respectively, and 0, 3.3%, 3.4%, 16.0%, and 30.0% at 12-month follow-up, respectively, both with significant differences (χ = 16.26, P = 0.009 at 6-month follow-up, and χ = 49.05, P < 0.001 at 12-month follow-up). The logistic analysis confirmed that eGFR was one of independent risk factors of CI-AKI in emergency PCI patients.@*Conclusions@#High level of eGFR might be associated with increased risk of CI-AKI in patients with emergency PCI, implying for future studies and risk stratification in clinical practice.

Clinical Value of Platelet Distribution Width Ratio and Neutrophil Lymphocyte Ratio in the Evaluation of Coronary No-Reflow in Patients Treated by Emergency PCI / 现代生物医学进展

Objective:To investigate the clinical value ofplatelet distribution width ratio (RDW) and neutrophil lymphocyte ratio (NLR) in the prediction of coronary no reflow in patients treated with acute percutaneous coronary intervention (PCI).Methods:66 patients underwent emergency PCI treatment in our hospital from January 2016 December 2016 were selected as the research object,RDW and NLR of the patients before treatment were detected,and coronary no reflow phenomenon after emergency PCI rate were statistically calculated.RDW and NLR of patients with no reflow and normal blood flow were compared,the relationship between RDW and NLR with no reflow and the value of them predicting coronary no reflow were analyzed.Results:The incidence of coronary no reflow after emergency PCI was 30.30％ (20/66).Compared with patients with normal blood flow,the RDW and NLR of patients with coronary no reflow were elevate (P＜0.05).Spearman correlation analysis results showed that RDW and NLR were positively correlated with coronary no reflow (r=0.826,0.878,P＜0.05).Further ROC curve analysis showed that AUC of preoperative RDW combined with NLR predicting the postoperative coronary no reflow in patients treated with emergency PCI were higher than RDW and NLR alone.Conclusion:RDW and NLR in patients treated with emergency PCI were closely related to the postoperative coronary no reflow,which might be used as reference index for evaluation of coronary no reflow after emergency PCI.

Clinical efficacy and safety of ticagrelor, a new antiplatelet agent P2Y12, in patients with acute ST segment elevation myocardial infarction underwent emergency PCI / 中国综合临床

Objective To observe the clinical efficacy and safety of ticagrelor,a new antiplatelet agent,in patients with ST-Segment elevation myocardial infarction (STEMI) underwent emergency PCI.Methods Selected 174 patients with STEMI receiving emergency PCI treatment from January 2013 to July 2014 in Nanjing General Hospital of Nanjing Military Area Command,and randomly divided into clopidogrel group (preoperative taking 600 mg of clopidogrel,n =88) and ticagrelor group (preoperative taking 180 mg of ticagrelor,n =86).Compared platelet inhibition rate,renal function before and after treatment,major clinical cardiovascular events and bleeding events 30 d after treatment,adverse drug reactions of two groups.Results (1) Arachidonic acid pathway inhibition rate of the two groups were compared,the difference was not statistically significant (P ＞0.05).Compared two groups of patients with adenosine phosphate pathway inhibition rate,ticagrelor group was higher,the difference was statistically significant ((71.82 ± 19.97) ％ vs.(38.96 ± 27.55) ％;t =-7.569,P ＜0.001).(2) Compared major cardiovascular events of ticagrelor group(5 cases) and clopidogrel group (15 cases),ticagrelor group was decreased.There was significant differences (P =0.02) between the two groups.Bleeding events compared to between ticagrelor group (15 cases) and clopidogrel group (11 cases),no statistically significant difference was found(P =0.617).Conclusion Clinical efficacy of ticagrelor in acute ST-segment elevation myocardial infarction treated with primary PCI is superior to clopidogrel in which can reduce the risk of cardiovascular events in patients and without an increase in severe bleeding.

Effect of thrombus aspiration on myocardial reperfusion during mergency percutaneous coronary intervention / 中国综合临床

Objective To evaluate the effects of thrombus aspiration on postoperative clinical prognosis of acute ST-segment elevation myocardial infarction (STEMI) patients with emergency percutaneous coronary intervention(PCI).Methods From September 2009 to January 2012,a total of 239 patients with STEMI undergoing emergency PCI (thrombus aspiration + PCI (n =118) and PCI (n =121)) were enrolled in this study.The angiographic and clinical results were retrospectively analyzed and compared between the two groups of patients.Results There were significant differences between the thrombns aspiration group and the PCI group on instant blood flow TIMI3 grade (106 (89.8％) vs.96 (79.3％) ; x2 =5.026,P ＜ 0.05),ST-segment depression rate at two hours after surgery (101 (85.6％) vs.90 (75.2％) ; x2 =5.500,P ＜ 0.05),ejection fraction within one week after surgery (68 (57.6％) vs.52 (43.0％) ; x2 =5.130,P ＜ 0.05),incidence of reinfarction during hospitalization (0 (0) vs.5 (4.1％) ; x2 =4.980,P ＜ 0.05).There were no significant statistical difference between the two groups on the average length of stay ((10.05 ± 5.40) d vs.(10.40 ± 5.03) d; t =-0.525,P ＞ 0.05),incidence of ventricular fibrillation during surgery (4 (3.4％) vs.3 (2.5 ％ ; x2 =0.174,P ＞ 0.05),heart failure during hospitalization (15 (12.7％) vs.18 (14.9％) ; x2 =0.235,P ＞0.05),Malignant arrhythmias (12 (10.2％) vs.15 (12.4％) ; x2 =0.296,P ＞ 0.05),and mortality rate (2 (1.7％) vs.5(4.1％);x2 =1.248,P ＞0.05).Conclusion Application of thrombus aspiration,which is a safe and effective way,may improve the clinical outcomes in acute ST-segment elevation myocardial infarction patients with emergency PCI.

Application of Percolse, Angio-Seal Vascular Closure Devices or Manual Compression in Emergency Percutaneous Coronary Intervention / 中国康复理论与实践

@#ObjectiveTo assess the value of Percolse, Angio-Seal vascular closure devices in emergency percutaneous coronary intervention. Methods603 patients undergoing emergency percutaneous coronary intervention were divided into manual compression group (n=160), Perclose group (n=237) and Angio-Seal group (n=206). The time of hemostasis, time of immobilization and the incidence of vascular complications were observed in each group. ResultsThe time of hemostasis, time of immobilization in vascular closure devices groups were significantly shorter than those in manual compression group (P<0.01). The incidence of vascular complications were significantly lower than those in manual compression group (P<0.01). There was no difference between Perclose group and Angio-Seal group (P>0.05). The rate of successful hemostasis was not significantly different among each group (P>0.05). ConclusionThe Perclose and Angio-Seal vascular closure device is safe and reliable hemostasis in emergency percutaneous coronary intervention.