Safety and efficacy of regional transport combined with PCI model in patients with STEMI after thrombolysis in northwest China / 中华心血管病杂志

Objective: To investigate the safety and efficacy of regional transport to percutaneous coronary intervention(PCI) hospitals from non-PCI hospitals after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI) in northwest China. Methods: In this retrospective study, 1 062 STEMI patients who were transferred from non-PCI hospitals within 24 hours from symptom onset, during January 2015 and January 2019 in the First Hospital of Lanzhou University, were included. According to the treatment strategy, they were divided into two groups, namely intravenous thrombolysis combined with PCI group(n=240), and primary PCI group(n=822). Observation endpoint were in-hospital adverse cardiovascular and cerebrovascular events and bleeding events, Including all-cause death, ischemic stroke, malignant arrhythmia, intracranial hemorrhage and hemorrhage with hemoglobin decrease≥50 g/L. Results: A total of 1 062 STEMI patients were included(age was (61±12) years old), with 905 males (85.2%). The proportion of grade 0 TIMI blood flow in the primary PCI group before operation was significantly higher than that in the thrombolysis combined with PCI group(63.0%(518/822) vs. 36.3%(87/240)， P<0.001). Compared with primary PCI group, the time from symptom onset to first medical contact(2.11(1.00, 4.00)hours vs.3.00(1.13, 7.07)hours, P<0.001) and reperfusion in thrombolysis combined with PCI group(3.07(1.83, 4.87)hours vs. 6.92(4.07, 11.15) hours, P<0.001) were significantly shorter. The proportion of all-cause death was significantly higher in the primary PCI group than that in the thrombolysis combined with PCI group (1.8%(15/822) vs. 0, P=0.03). There was no significant difference in hemorrhage, ischemic stroke and malignant arrhythmia between the two groups(all P>0.05). Conclusions: For STEMI patients initially hospitalized in non-PCI hospitals, regional transport combined with PCI is feasible and effective. It does not significantly increase the risk of bleeding and cardiovascular and cerebrovascular events, with shorter time from symptom onset to myocardial reperfusion.

Relationship Between Plasma Level of Neutrophil Gelatinase-associated lipocalin and Coronary Lesion Severity in Patients With Acute ST-elevation Myocardial Infarction / 中国循环杂志

Objective: To study the relationship between plasma levels of Neutrophil gelatinase- associated lipocalin (NGAL), matrix metalloproteinase (MMP-9), hs-CRP, IL-1β and the severity of coronary stenosis in acute ST-elevation myocardial infarction (STEMI) patients without kidney disease; to explore the ability for NGAL discriminating severe coronary stenosis. Methods: Our research included in 2 groups: STEMI group, n=124 patients admitted in our hospital from 2014-01 to 2017-03 and Control group, n=124 subjects without obvious coronary stenosis. According to SYNTAX score, the patients were divided into another set of 2 groups: High score group, patients with SYNTAX score ≥ 33, n=26 and Low score group, patients with SYNTAX score < 33, n = 98. Relationship between plasma levels of NGAL, MMP-9, hs-CRP, IL-1β and the severity of coronary stenosis were studied by Spearman correlation analysis; the ability for NGAL discriminating severe coronary stenosis was examined by ORC curve; the influencing factors for SYNTAX score were determined by Logistic regression analysis. Results: Compared with Control group, STEMI group had increased plasma levels of NGAL, MMP-9, hs-CRP, all P < 0.01,while IL-1β was similar between 2 groups, P=0.272. NGAL was positively related to MMP-9 (r=0.757, P<0.01), SYNTAX score (r=0.616, P<0.01) and IL-1β (r=0.185, P<0.05). Compared with Low score group, High score group showed the higher plasma levels of NGAL, MMP-9, both P<0.01, while the lower LVEF, P<0.01. The area under ROC curve for NGAL discriminating severe coronary stenosis was 0.881 (95% Cl 0.813-0.949, P<0.01) which was greater than MMP-9 [0.799 (95% Cl 0.709-0.890, P<0.01)] and hs-CRP [0.446 (95% Cl 0.306-0.587, P=0.400)]. Multivariate regression analysis presented that plasma NGAL level was independently related to high SYNTAX score [OR=1.115, 95% Cl (1.107-1.123), P<0.01]. Conclusion: STEMI patients had increased plasma levels of NGAL, MMP-9 and hs-CRP; NGAL had better ability for discriminating severe coronary stenosis than MMP-9 and hs-CRP. NGAL as a new biomarker should be helpful for risk stratification in STEMI patients.

Perioperative sustained renal replacement therapy for percutaneous coronary intervention i patients with severe acute myocardial infarction / 中国介入心脏病学杂志

Objective To evaluate the safety and efficacy of continuous renal replacement therapy (CRRT) during percutaneous coronary intervention (PCI) in patients with severe acute myocardial infarction (AMI). Methods A total of 945 patients with AMI who were hospitalized in the CCU of the First Hospital of Lanzhou University from January 2016 to December 2017 were retrospectively analyzed and 21 patients had undergone perioperative CRRT during percutaneous coronary intervention. Baseline clinical characteristics of the AMI patients were evaluated before and after CRRT treatment. The changes in heart function, renal function, liver function and other parameters were evaluated. Results The heart rate of patients receiving CRRT was significantly lower at 24h and 48h after CRRT than that of before treatment (P=0.038). Decrease in mean systolic blood pressure and diastolic blood pressure was observed af ter CRRT treatment without statistical significance (P>0.05). Proportion of patients with Killip class I ~ II heart function increased significantly after CRRT[23.8%(5/21)vs. 57.1%(12/21),P=0.001]. Amelioration in urea nitrogen, creatinine, aspartate aminotransferase, glutamic pyruvic transaminase and total bilirubin were found at 24h and 48h after CRRT treatment compared to pre-CRRT levels (P<0.05). Conclusions Perioperative CRRT is safe and effective for patients with severe AMI.