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Objective To examine the use of reperfusion strategies in elderly patients with acute myocardial infarction (AMI) and investigate the factors affecting its use. Methods This survey population consisted of 338 consecutive elderly patients with AMI( t65 years) who were admitted to the department of cardiology of Beijing Military General Hospital between December 2003 and November 2007. The patients were divided into two groups based on the receiving of reperfusion strategies : a reperfusion group ( n = 252) and a non-reperfusion therapeutic group ( n = 86). Qualitative data were compared between the two groups using Chi-square tests and multiple binary logistic regression was used to determine the relationship between various patient-related factors with the probability of choosing reperfusion therapies or not. Results About 74. 6% of the elderly patients with AMI recevied reperfusion strategies [62. 2% pereutaneons coronary intervention (PCI) and 12.4% thrembelysis]. Stepwise logistic regression analysis revealed that age ≥ 75 years( OR = 0. 255, P = 0. 000), history of angina ( OR = 0. 570, P = 0. 016 ) and high Killip classification ( OR =0. 671 ,P =0. 012) were confirmed factors for receiving less reperfusion therapy. Meanwhile, inferior wall myocardial infarction (MI) with complicating right ventricular MI( OR =4. 585,P =0. 002) ,sweating ( OR = 1. 970, P = 0. 016), unbearable symptoms ( OR = 1. 836, P = 0. 038 ) and medical insurance ( OR =1. 968,P =0. 029) were independent predictors for receiving reperfusion therapy. Intracranial hemorrhage (2.8% vs 7. 1%,P =0.000), left ventricular ejection time <45% (12% vs 31%,P =0.016) and mortality rate within 1 year(2. 3% vs 4. 7%, P = 0. 039) were obviously decreased in the PCI group as compared with the thrembelysis group. Conclusions Aging, medical history of angina, high Killip classification, inferior MI with complicating fight ventricular MI, sweating, unbearable symptoms and medical insurance were independent predictors for receiving reperfusion strategies.
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@#Objective To initially evaluate the coronary arterial remodeling of the patients with coronary artery disease by use of intravascular unltrasound(IVUS).Methods 28 consecutive patients with coronary artery disease were randomly divided into the acute coronary syndrome(ACS)group(n=18)and stable angina group(n=10).The area of plaques,the area of extra-elasticity membrane(EEM)of vascellum and plaque burden as well as remodeling index(RI)of coronary arteries were measured by IVUS in two groups.The plasma levels of high sensitivity C-reactive protein(hs-CRP),matrix metalloproteinase(MMP,including MMP-2 and MMP-9),CD40 ligand(CD40L)and pregnancy associated plasma protein-A(PAPP-A)were measured by ELISA.Results The area of plaques(P=0.000),the area of EEM(P=0.003)and plaque burden of "criminal" lesions(P=0.037)in the patients of the ACS group increased more significantly than that of the control group.The incidence of high-risk plaques(P=0.028)and RI(P=0.015)in the ACS group increased more significantly than that of the control group.The positive remodeling was more common in the ACS group(P=0.040),while negative remodeling in the control group(P=0.039).The plasma levels of MMP-2(P=0.011),MMP-9(P=0.001)Pand CD40L(P=0.034)in the high-risk plaques group were significantly higher than those in the non-high-risk plaques group.There were no significant differences of the plasma levels of hs-CRP(P=0.190),MMP-2(P=0.255),MMP-9(P=0.574),CD40L(P=0.342),PPAP-A(P=0.403)and the incidence of high-risk plaques(P=0.566)in the positive and negative as well as none remodeling groups.Regression analysis showed that only the regression coefficient of ACS and stable angina by RI were significant(P<0.05),the Pregression equation was RI=0.179-0.131 group(group stands for ACS group and stable angina group).Conclusion The clinical types of coronary artery disease may be an independent predictor of the coronary arterial remodeling measured by IVUS.