Impact of diabetes and stroke on long-term outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention / 中华全科医师杂志

Objective:To investigate the impact of diabetes mellitus (DM) and stroke on long-term outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods:Total 411 consecutive ACS patients undergoing PCI at the Ninth People′s Hospital of Zhengzhou between December 2014 and June 2018 were recruited, including 319 males and 92 females with a mean age of (64.7±10.1) years. These patients were divided into 4 groups according to the presence or absence of history of diabetes or stroke: non-DM non-stroke group ( n=192) , DM group ( n=140), stroke group ( n=41), and DM+stroke group ( n=38). The data of baseline demographic characteristics, clinical feature, coronary angiographic findings, and cardiovascular adverse events during long-term follow-up were obtained. Kaplan-Meier curves were used to investigate the long-term clinical outcomes among groups. Results:The mean interval of follow-up was (24.1±13.8) months. Patients with DM+stroke had the highest rates of non-fetal myocardial infarction (χ 2=24.932) , non-fetal stroke (χ 2=9.434) , hospitalization due to heart failure/angina (χ 2=69.290) , revascularization (χ 2=22.918) , cardiovascular death(χ 2=13.473)and all-cause death(χ 2=17.724)as well as hard endpoint events (the sum of non-fetal myocardial infarction, non-fetal stroke, and all-cause death) (χ 2=30.268)and combined major adverse cardiovascular events (MACE) (the sum of hard endpoint events, hospitalization due to heart failure/angina, and revascularization) (χ 2=119.556)among 4 groups(all P<0.01). In Kaplan-Meier survival analysis, the cumulative ratio of freedom from all-cause death decreased significantly in DM+stroke group compared with no DM no stroke group ( HR=17.121, 95 %CI: 2.527-115.934, P<0.01), but no statistical difference was observed in the cumulative ratio of freedom from all-cause death between DM+stroke group and DM group or stroke group respectively ( HR=3.178, 95 %CI: 0.744-13.582; HR=1.383, 95 %CI: 0.374-5.118; all P>0.05) . Meanwhile, patients with DM+stroke presented significantly lower cumulated ratio free from combined MACE than patients with non-DM non-stroke ( HR=5.423, 95 %CI:2.941-10.036, P<0.01), and the cumulated ratio free from combined MACE also decreased significantly in DM+stroke group as compared to DM group or stroke group respectively ( HR=1.859,95 %CI: 1.167-2.962; HR=1.991,95 %CI: 1.178-3.364; all P<0.01) . Conclusions:ACS patients with combined history of DM and stroke have a worse long-term outcomes after PCI than those with DM alone or stroke alone or without DM or stroke. DM and stroke seemed to have an additive effect on decrease in the cumulative ratio free from combined MACE in ACS patients following PCI.

Improvement Effects of 3 Kinds of Angiotensin Converting Enzyme Inhibitor on Ventricular Remodeling in Patients with Acute Myocardial Infarction / 中国药房

OBJECTIVE: To observe the improvement effects of angiotensin converting enzyme inhibitor (ACEI) fosinopril, perindopril and benazepril on ventricular remodeling in patients with acute myocardial infarction (AMI), and to evaluate its safety. METHODS: A total of 96 AMI patients selected from our hospital during Jan. 2014-Oct. 2016 were divided into group A, B, C according to random number table, with 32 cases in each group. All patients received symptomatic treatment, underwent percutaneous coronary intervention, and then given ACEI after blood vessels recanalization and keeping blood pressure stable. Group A was given Fosinopril sodium tablets 10 mg, qd; group B was given Perindopril tert-butylamine tablets 4 mg, qd; group C was given Benazepril hydrochloride tablets 10 mg, qd. All groups were treated for consecutive 6 months. Cardiac structure and function indexes (LVESD, LVEDD, IVSD, LVPWD, LVEF, CO), hemodynamic indexes (SBP, DBP, HR) and related lab indexes (FPG, TG, TC, HDL-C, LDL-C, AST, ALT, Scr, BUN) of 3 groups were observed before and after treatment. The occurrence of ADR was recorded. RESULTS: Before treatment, there was no statistical significance in cardiac structure and function indexes, hemodynamic indexes or related lab indexes among 3 groups (P＞0. 05). After treatment, the levels of LVESD, LVEDD, LVPWD, CO, HR, FPG, TG, TC and LDL-C in 3 groups were decreased significantly, while the levels of LVEF and SBP were increased significantly, with statistical significance (尸＜0. 05). There was no statistical significance in above indexes among 3 groups after treatment (P＞0. 05). After treatment, the level of Scr in group B was significantly increased and higher than group A and C, with statistical significance (P＜0. 05). There was no statistical significance in the levels of IVSD, DBP, HDL-C, AST, ALT or BUN among 3 groups before and after treatment as well as the level of Scr between group A and C (P＞ 0. 05). There was no statistical significance in the incidence of ADR among 3 groups(P＞0. 05). CONCLUSIONS: Fosinopril, perindopril and benazepril can significantly improve ventricular remodeling in AMI patients, narrowing the heart cavity, increasing systolic pressure, lowering heart rate, reducing the oxygen consumption of the ventricle, with similar effects. Perindopril may increase the level of Scr, so fosinopril and benazepril are safe and suitable for AMI patients with renal function disorder.

Prognostic value of cystatin C and creatinine in chronic heart failure in patients aged over 75 years / 西安交通大学学报(医学版)

ABSTRACT:Objective To compare the prognostic value of cystatin-C (Cys-C)and creatinine (Cr)in chronic heart failure (CHF)in old people.Methods We recruited 183 old patients (>75 years)diagnosed with CHF hospitalized at the Department of Cardiology and the Department of Geriatrics of our hospital from 2010 to 2012. Venous blood was withdrawn to detect the expressions of Cys-C and Cr.After three-year follow-up,the patients’ three-year survival was recorded.Logistic regression model was used to examine the relationship of Cys-C,Cr and other risk factors with the CHF patients’mortality.ROC curve was used to compare the prognostic value of Cys-C and Cr in CHF in old people and statistical method was adopted to analyze the combined use of Cys-C and Cr for determining their value in evaluating CHF prognosis.Results At the end of the follow-up,74 (40.44%)patients died.Serum cys-C and Cr levels of the patients in death group increased compared with those in survival group (P<0.05).Multivariate logistic regression showed that age (OR=1.11,95% CI=1.04-1.19),SBP (OR=1.06,95%CI=1.01-1.10),LVEF (OR=0.89,95% CI=0.82-0.95),BNP (OR=4.74,95% CI=1.77-12.69), creatinine (OR=2.04,95% CI=1.03-4.08),and Cys-C (OR=2.97,95% CI=1.44-6.12)were the independent risk factors for the prognosis of CHF.ROC analysis showed that Cys-C was superior to creatinine in AUC value (0.71 vs.0.65;95% CI,0.64-0.78;95% CI,0.58-0.72)(P<0.001).The AUC value of Cys-C and Cr in combination was 0.73 (95% CI,0.66-0.79).Conclusion Cys-C is a stronger predictor of the prognosis of CHF patients than creatinine and the combination of the two can increase the sensitivity and specificity in evaluating the prognosis of patients with CHF.

Efficacy of recombinant tissue-type plasminogen activator thrombolysis and primary coronary stenting after acute myocardial infarction / 中华医学杂志(英文版)

<p><b>OBJECTIVE</b>To compare the efficacy of low dose recombinant tissue-type plasminogen activator (rt-PA) thrombolysis with primary coronary stenting after acute myocardial infarction.</p><p><b>METHODS</b>Of 261 patients with first acute myocardial infarction, 131 were given low dose rt-PA intravenous thrombolysis, and 130 primary coronary stenting.</p><p><b>RESULTS</b>The age, time from onset of chest pain to hospital presentation and infarct location between these two groups were comparable. The patency rate of the infarct-related artery (IRA) in patients in the thrombolysis group was significantly lower than that of patients in the primary stenting group (P < 0.001). Recurrent myocardial infarction, and selective coronary stenting of patients with thrombolytic therapy were higher than that of patients in the primary stenting group (7.6% vs 1.5%, P < 0.05; 20.6% vs 0, P < 0.001, respectively). Left ventricular ejection fraction (LVEF) in patients in the thrombolysis group was lower than that of the stent group (55.6% +/- 13.4% vs 65.8% +/- 9.2%, P < 0.001). Total hospitalization time of the thrombolysis group was longer than that of the stent group (16 +/- 7 d vs 11 +/- 4 d, P < 0.001). Mortality in the thrombolysis group was higher than that of the stent group, but this difference was not significant (6.1% vs 3.1%, P > 0.05).</p><p><b>CONCLUSION</b>Comparing with low dose rt-PA thrombolytic therapy after acute myocardial infarction, primary coronary stenting has a higher patency rate of the IRA, better cardiac function and shorter hospitalization time.</p>

Analysis of factors associated with delay time of treatment in patients with acute myocardial infarction / 中华全科医师杂志

90 min group than in ≤90 min group.Multivariate logistic regression analysis showed that age,diabetes,atypical angina,onset at night all were independently associated with prehospital delay (all P

The long-term clinical outcomes in patients with anterior wall and non-anterior wall acute myocardial infarction referred to primary percutaneous coronary intervention / 中国介入心脏病学杂志

Objective To investigate the long-term clinical outcomes in patients with anterior wall acute myocardial infarction ( AW-AMI) and non AW-AMI ( NAW-AMI) referred to primary percutaneous coronary intervention (P-PCI). Methods 287 patients with AMI who consecutively underwent primary PCI were divided into AW-AMI group (142 cases) and NAW-AMI group (145 cases) according to different location of myocardial infarction. The baseline characteristics and coronary artery lesions of patients were analysed. The primary end points were in-hospital mortality and the major cardiovascular events (MACE) during a mean 17.3?9.8 month follow-up including the occurrences of non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization of target vessels and overall cardiac-related death. Results The peak value of CK and CK-MB were significantly higher (3 533?2 888) U/L vs (2 322 ? 1 638)U/L, (158 ? 197) U/L vs (95 ? 64) U/L, all P