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Introduction@#Red cell distribution width (RDW) is a parameter that is readily available as part of a standard complete blood count (CBC). Studies have shown that an elevated RDW is associated with increased cardiovascular events including acute coronary syndrome (ACS). This cross- sectional retrospective study was conducted to determine the association of RDW in patients with ACS admitted to Bataan General Hospital and Medical Center (BGHMC).@*Methods@#A cross-sectional study was performed in a 500-bed tertiary care hospital in Bataan, Philippines. The clinical medical records of patients with ACS were analyzed retrospectively. A total of 811 patients was admitted as cases of ACS from January 2017 to December 2019. Using Slovin’s formula, the computed sample size was 261 patients. However, only 205 cases were included in the study in accordance to the eligibility criteria. The baseline RDW were recorded from the CBC obtained upon admission of patients with ACS.@*Results@#Based on the data collected from January 2017 to December 2019 from patients admitted to BGHMC, there was no significant association between RDW and in-house morbidity and mortality and classification of ACS.@*Conclusions@#There were no significant association between RDW and in-house morbidity and mortality and classification of ACS. The authors recommend to conduct the study for a longer duration to have more population included and to include other parameters such as cardiac enzymes, electrocardiogram (ECG) changes and presence of co-morbidities.
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Índices de Eritrócitos , Síndrome Coronariana Aguda , Angina Instável , Infarto do Miocárdio com Supradesnível do Segmento STRESUMO
Introducción: la fibrilación auricular es la taquiarritmia sostenida más frecuente del ser humano. Su manejo requiere un abordaje holístico para que los resultados sean óptimos, por lo que se considera la epidemia cardiovascular del siglo XXI. Objetivo: establecer las variables ecocardiográficas asociadas al fracaso de la cardioversión en pacientes con diagnóstico clínico de fibrilación auricular y síndrome coronario agudo. Materiales y métodos: se realizó un estudio retrospectivo, analítico, no experimental de casos y controles en pacientes con fibrilación auricular y síndrome coronario agudo, durante el período comprendido entre los años 2017 y 2021. Resultados: la cardioversión eléctrica se observó en 55 pacientes (68,8 %) (OR = 0,24; IC 95 %: 0,08-0,7; p = 0,008). La terapia trombolítica se aplicó en 47 pacientes (58,8 %) (OR = 5,03; IC 95 %: 1,67-15,12; p = 0,0026). En cuanto a parámetros ecocardiográficos, la variable volumen de la aurícula izquierda ≥ 34 ml/sc predominó en 50 pacientes (62,5 %) (OR = 3,5; IC 95 %: 1,22-10,04; p = 0,016); la presión de la aurícula izquierda > 15 mmHg en 23 pacientes (OR = 3,61; IC 95 %: 1,23-10,54; p = 0,015), y el diámetro del ventrículo izquierdo > 57 mm en 20 pacientes (OR = 4,33; IC 95 %: 1,35-13,87; p = 0,009). Conclusiones: el volumen de la aurícula izquierda elevada, la presión de aurícula izquierda, el diámetro del ventrículo izquierdo, la terapia eléctrica y trombolítica, se asocian al fracaso de la cardioversión en pacientes con fibrilación auricular e infarto agudo de miocardio.
Introduction: atrial fibrillation is the most frequent sustained tachyarrhythmia in humans. Its management requires a holistic approach for the results to be optimal; it is considered the cardiovascular epidemics of the 21st century. Objective: to establish echo-cardiographic variables associated with cardioversion failure in patients with clinical diagnosis of atrial fibrillation and acute coronary syndrome. Materials and methods: a retrospective, analytical, non-experimental study of cases and controls was carried out in patients with atrial fibrillation and acute coronary syndrome, during the period between 2017 and 2021. Results: electrical cardioversion was observed in 55 patients (68.8%) (OR = 0.24; CI 95%: 0.08-0.7; p = 0.008). Thrombolytic therapy was applied in 47 patients (58.8%) (OR = 5.03; CI 95%: 1.67-15.12; p = 0.0026). Regarding echocardiographic parameters, the variable left atrial volume ≥ 34 ml/sc predominated in 50 patients (62.5%) (OR = 3.5; CI 95%: 1.22-10.04; p = 0.016); left atrial pressure > 15 mmHg predominated in 23 patients (OR = 3.61; CI 95%: 1.23-10.54; p = 0.015), and left ventricular diameter > 57 mm in 20 patients (OR = 4.33; CI 95%: 1.35-13.87; p = 0.009). Conclusions: elevated left atrial volume, left atrial pressure, and left ventricular diameter, electric and thrombolytic therapy, are all associated to cardioversion failure in patients with atrial fibrillation and acute myocardial infarction.
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Abstract Background: The strain parameters of Real-Time Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) are GLS, GAS, GRS, and GCS, while each index can significantly diagnose Acute Myocardial Infarction (AMI) patients, but none of them can distinguish between NSTEMI and STEMI. MicroRNAs (miRNAs) play essential roles in Acute Myocardial Infarction (AMI), but little is known about the value of exosome miRNA combined with RealTime Three-Dimensional Spot Tracking Echocardiography (RT3D-STE) between ST-segment Elevation Myocardial Infarction (STEMI) and Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Aim: To estimate the exosomal miRNAs related to strain parameters of RT3D-STE as biomarkers for early detection of STEMI and NSTEMI. Methods: The present study collected plasma samples from thirty-four (34) patients with AMI (including STEMI and NSTEMI) and employed high-throughput sequence technology and real-time quantitative polymerase chain reaction (RT-qPCR) to identify the differentially expressed miRNAs. The Pearson correlation coefficient is used to measure the strength of a linear association between differentially expressed miRNAs and strain parameters of RT3D-STE. Results: Twenty-eight (28) differentially expressed exosomal miRNAs were universally identified between STEMI, NSTEM, and normal groups. Among them, there are 10 miRNAs (miR-152-5p, miR-3681-5p, miR-193a-5p, miR-193b-5p miR-345-5p, miR-125a-5p, miR-365a-3p, miR-4520-2-3p, hsa-miR-193b-3p and hsa-miR-5579-5p) with a Pearson correlation greater than 0.6 with RT3D-STE strain parameters. Especially, miR-152-5p and miR-3681-5p showed the most significant correlation with RT3D-STE strain parameters. Target genes of these 10 miRNAs are analyzed for Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways enrichment, and they were found to be mainly involved in the cellular metabolism processes and HIF-1 signaling pathway. RT-qPCR verified the significant differential expression of miR-152-5p and miR-3681-5p between STEMI and NSTEM groups. Conclusion: RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. If the RT3D-STE is abnormal, the exosome miRNAs can be detected again to obtain more detailed and accurate diagnostic results between STEMI and NSTEM groups. Exosomal miR-152-5p and miR-3681-5p may serve as potential biomarkers for ST-segment elevation myocardial infarction. HIGHLIGHTS RT3D-STE and exosome miRNAs can be used as a hierarchical diagnostic system in AMI. Exosomal miR-152-5p and miR-3681-5p function as potential biomarkers for ST-segment elevation myocardial infarction.
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Objective:To assess the left ventricular myocardial function in non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal wall motion and left ventricular ejection fraction (LVEF) after percutaneous coronary intervention(PCI) by noninvasive myocardial work technology, and to explore the evolution of left ventricular myocardial function recovery.Methods:A total of 92 NSTE-ACS patients from July to December 2019 in Beijing Chao Yang Hospital with normal wall motion and LVEF (>55%) after PCI were recruited. Echocardiography was performed 1 day before PCI, 1 day, 2 weeks, 1 month, and 3 months after PCI. Global longitudinal strain (GLS) was analyzed, and Brachial cuff systolic pressure was used as left ventricular pressure to construct a non-invasive left ventricular pressure-strain loop. Global myocardial work index (GWI), global constructive work (GCW), global waste work (GWW), global myocardial work efficiency (GWE) among groups were compared and their correlations with strain parameters were explored.Results:GWI, GCW, GWE were improved ( P<0.05) at 1 day after PCI, GLS improved ( P<0.05) and GWW decreased ( P<0.05) at 2 weeks, LVEF improved ( P<0.05) at 1 month. Baseline GWI and GCW had a moderately negative correlation with GLS ( r=-0.67, -0.66; both P<0.05); GWW had a moderately positive correlation with mechanical dispersion(MD) and postsystolic shortening index(PSI) ( rs=0.45, 0.50; both P<0.05); GWE had a moderately negative correlation with GLS, MD and PSI ( rs=-0.47, -0.55, -0.56; all P<0.05). Conclusions:Left ventricular myocardial function gradually improves in NSTE-ACS patients with normal wall motion and LVEF after PCI. Myocardial work parameters changes are more sensitive than GLS and LVEF, and can assess early left ventricular myocardial function changes after PCI.
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Objective:To explore the safety and efficiency of percutaneous coronary intervention (PCI) in maintenance hemodialysis patients combined with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods:The clinical data of 52 maintenance hemodialysis patients combined with NSTE-ACS from January 2010 to January 2015 in Dalian Central Hospital were retrospectively analyzed. Among of them, 25 patients were treated with common drugs (control group), and 27 patients were treated with common drugs combined with PCI (PCI group). The major adverse cardiac events (MACE) duration of hospital stay were record, including hemorrhage, malignant arrhythmia, new heart failure or aggravation, stroke and all-cause death. The dialysis complications within 1 month after treatment were recorded, including hypotension, arrhythmia, heart failure and angina pectoris. The patients were followed up for 12 months, the MACE 1, 6 and 12 months after treatment were recorded, including angina pectoris, heart failure and cardiac death.Results:Duration of hospital stay, the incidences of malignant arrhythmia and new heart failure or aggravation in PCI group were significantly lower than those in control group: 18.5% (5/27) vs. 44.0% (11/25) and 7.4% (2/27) vs. 32.0% (8/25), and there were statistical differences ( P<0.05); there were no statistical difference in the incidences of hemorrhage, stroke and all-cause death between the two groups ( P>0.05). The incidences of dialysis complications such as hypotension, arrhythmia, heart failure and angina pectoris within 1 month after treatment in PCI group were significantly lower than those in control group: 24.0% (6/25) vs. 56.5% (13/23), 16.0% (4/25) vs. 43.5% (10/23), 12.0% (3/25) vs. 47.8% (11/23) and 24.0% (6/25) vs. 52.2% (12/23), and there were statistical differences ( P<0.05 or <0.01). The follow-up results showed that the incidences of angina pectoris and heart failure 1, 6 and 12 months after treatment in PCI group were significantly lower than those in control group, angina pectoris: 28.0% (7/25) vs. 65.2% (15/23), 29.2% (7/24) vs. 76.2% (16/21) and 43.5% (10/23) vs. 17/17, heart failure: 16.0% (4/25) vs. 43.5% (10/23), 8.3% (2/24) vs. 33.3% (7/21) and 21.7% (5/23) vs. 10/17, and there were statistical differences ( P<0.05 or <0.01); there was no statistical difference in the incidence of cardiac death 1 and 6 months after treatment between two groups ( P>0.05), the incidence of cardiogenic death 12 months after treatment in PCI group was significantly lower than that in control group: 8.6% (2/23) vs. 9/17, and there was statistical difference ( P<0.01). Conclusions:PCI is safe and effective for maintenance hemodialysis patients combined with NSTE-ACS.
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Objective:To analyze the syndrome characteristics and distribution regularity of patients with non-ST segment elevation myocardial infarction (NSTEMI), in order to guide clinical practice and improve the efficacy of traditional Chinese medicine. Method:Inpatients with non-ST segment elevation myocardial infarction in line with the diagnostic criteria were selected, and the frequency statistics method was used to analyze the syndrome elements and their frequency degree and distribution characteristics. Result:According to the analysis of syndrome elements and their frequency degree of 263 patients with NSTEMI, the pathogenesis of NSTEMI was mostly deficiency in origin and excess in superficiality. As for deficiency in origin, Qi deficiency (171 times, 32.39%) was the most common, which was followed by Yin deficiency (42 times, 7.95%), Yang deficiency (16 times, 3.03%), and blood deficiency (1 times, 0.19%). As for excess in superficiality, blood stasis (129 frequency, 24.4%) and phlegm turbidity (125 frequency, 23.7%) were the most common, which were followed by heat accumulation (42 frequency, 7.95%), water drinking (2 frequency, 0.38%). According to the syndrome diagnosis analysis of the combination of syndrome elements, 220 cases (83.65%) had single syndrome differentiation, 42 cases (15.97%) had two syndromes at the same time, and 1 case (0.38%) had three syndromes at the same time. Among all the syndrome types, Qi deficiency and blood stasis syndrome (94 cases, 42.7%) was the most common, which were followed by phlegm and blood stasis syndrome (46 cases, 20.9%), Qi and Yin deficiency syndrome (41 cases, 18.6%) and heart and kidney deficiency syndrome (32 cases, 14.6%). And Yang deficiency and water flooding syndrome (6 cases, 2.73%) and heart fire blazing syndrome (1 case, 0.45%) were relatively rare. According to the distribution regularity of syndrome, traditional Chinese medicine therapies were mainly for tonifying vital qi and protecting kidney Qi, with equal emphasis on removing phlegm, eliminating dampness and diuresis, activating blood circulation and removing blood stasis. Conclusion:The pathogenesis of NSTEMI is deficiency in origin and excess in superficiality. Deficiency in origin is mostly Qi deficiency and Yin deficiency, while excess in superficiality is mostly blood stasis, phlegm and heat accumulation. traditional Chinese medicine therapies are mostly for invigorating Qi and nourishing Yin, promoting blood circulation and removing blood stasis, clearing heat and resolving phlegm.
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Objective To evaluate the clinical value of thrombolysis in myocardial infarction (TIMI) and global registry of acute coronary events (GRACE) score systems in predicting the risk of in-hospital events in Chinese patients with non-ST-segment elevation myocardial infarction (NSTEMI). Methods Patients with NSTEMI admitted to the Department of Cardiovasology, Renji Hospital, Shanghai Jiao Tong University School of Medicine between Jan. 1 to Dec. 1, 2017 were consecutively enrolled. The end-point events were in-hospital mortality, reinfarction, heart failure, cardiac skock, and sudden cardiac arrest. Patients were scored by TIMI and GRACE score systems on hospital admission, and receiver operating characteristic (ROC) curve was used to evaluate the value of the two score systems and the combination of both in predicting in-hospital events. TIMI score was used to screen all the patients, and the TIMI medium-risk patients were further divided into GRACE high-risk subgroup (GRACE score≥140) and GRACE non-high-risk subgroup (GRACE score<140). The incidence of in-hospital events was compared between the two subgroups. Results A total of 232 patients were included in this study (163 males and 69 females, with an average age 66.1 years and 95% confidence interval [CI] 64.6-67.6 years). TIMI score grouped 69 (29.7%), 142 (61.2%) and 21 (9.1%) patients into low-, medium- and high-risk, and the incidence rates of in-hospital events were 14.5% (10/69), 24.6% (35/142) and 33.3% (7/21), respectively. GRACE score grouped 41 (17.7%), 85 (36.6%) and 106 (45.7%) paitents into low-, medium- and high-risk, and the incidence rates of in-hospital events were 7.3% (3/41), 11.8% (10/85) and 36.8% (39/106), respectively. GRACE score and TIMI score both demonstrated good discrimination and GRACE performed better for in-hospital events (area under curve [AUC] 0.81 vs 0.62, P<0.001). Further subgrouping the TIMI medium-risk group, we found that GRACE high-risk subgroup had significantly higher incidence rate of in-hospital events than the GRACE non-high-risk subgroup (38.2% [29/76] vs 9.1% [6/66], odds ratio 6.2, 95% CI 2.4-16.1, P<0.001). Combination of TIMI and GRACE scores improved the predictive value of in-hospital events (AUC=0.71, 95% CI 0.65-0.77), with a favorable higher positive predictive value than that of TIMI or GRACE score alone (37.1% vs 33.3% and 36.8%). Conclusion GRACE score has better predictive accuracy than TIMI score in Chinese NSTEMI patients, but sacrifices simplicity. The combination of GRACE and TIMI scores is an easy and effective discriminative tool in predicting in-hospital events in Chinese NSTEMI patients.
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Background: Coronary artery disease (CAD) has emerged as a major health burden in developing countries. Many recent reports concluded that women with CAD have a worse prognosis than men and also with regards to invasive interventions when compared to men. In this study, author determined the comparative outcomes of ACS in women when compared with men.Methods: This study was conducted in a tertiary care hospital from November 2016 to March 2018. History taking, ECG, cardiac enzymes, 2D-Echo and angiogram were done to diagnose ACS and the appropriate treatment was given. The severity was assessed and compared the outcomes along with complications.Results: The total of 112 patients were treated for ACS, in which, 55 were females and the remaining 57 were males. Majority of the patients in both genders was between the ages of 51-60. In males, STEMI noted 50.8%, NSTEMI in 36.8%, UA in 12.2%. In females, STEMI is noted in 62%, unstable angina in 32.7%, NSTEMI in 27.2%. Six patients (11%) had mortality in the women group and one (1.8%) had died among men.Conclusions: Atypical presentation of ACS was more common in females. Women with ACS had higher complications and higher mortality than men.
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@#Objective To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
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Objective To compare 12-month follow-up clinical outcome of an early to a delayed intervention in the management of high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods 758 consecutive high-risk NSTE-ACS patients treated with percutaneous coronary artery intervention(PCI)were enrolled between Jauary 2015 and December 2015 in Wuhan Asia Heart Hospital. They were divided into 2 groups according to diff erent intervention time, the early PCI group(within 24 h after diagnosis,n=185)and the delayed group (more than 24 h after diagnosis, n=573).The baseline clinical data, angiographic features, data related to PCI, the 12-month follow-up major adverse cardiac events (MACE) were analyzed retrospectively. MACE were defi ned as all-cause death and recurrent nonfatal myocardial infarction. Results Primary endpoint status after 12-month follow-up were collected in 711 of 758 initially enrolled patients. Incidence of MACE was 14.5% in the early and 11.2% in the delayed PCI group(χ2=1.289,P=0.256). No signifi cant diff erences were found in the occurrence of the individual components of all-cause death and nonfatal myocardial infarction. Mean hospital stay were(7.6±3.1)d in the early and (10.7±3.8)d in the delayed PCI group(t=2.489,P=0.014). Mean medical expenses in RMB were(48.5±13.5) thousand yuan in the early and(52.8±16.4)thousand yuan in the delayed PCI group(t=2.132,P=0.038). Conclusions After 12-month follow-up,no diff erence in incidence of MACE was seen between early and delayed invasive strategy,but with shorter hospital stay and reduced medical expenses.
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Objective To investigate the clinical characteristics and prognostic factors after percutaneous coronary intervention of women with the first non-ST-segment elevation myoeardial infarction.Methods A total of 123 female patients with AMI,including 70 patients with NSTEMI and 53 patients with ST-segment elevation myocardial infarction (STEMI),who received PCI within 24 hours of onset were selected from June 2013 to June 2015.The clinical data were compared between patients with NSTEMI and with STEMI.Cox regression model was used to analyze the prognostic factors for the elderly patients with NSTEMI.Results The female patients with NSTEMI had more cases of patients with hypertension (48 vs.26),diabetes (38 vs.38) and hyperlipidemia (52 vs.29)than the female patients with STEMI.Significant differences in systolic blood pressure [(134.31±22.26)mmHg vs.(125.04 ± 19.63) mmHg],levels of white blood cell [(9.02 ± 3.75) 109/L vs.(11.37 ± 3.63) 109/L] and troponin Ⅰ [(8.63 ± 18.34) μg/L vs.(18.79 ± 27.76) μg/L] were observed in the above two groups (l P ＜ 0.05,respectively).The rates of revascularization,major adverse cardiovascular events in NSTEMI group were higher than those in STEMI group during 1 year after discharge (47.7％ vs.28.0％,62.9％ vs.35.8％) (P ＜ 0.05,respectively).Cox survival analysis showed that white blood cell (HR =1.241) and troponin-Ⅰ (HR =1.026) elevation were the risk prognostic factors after PCI for women with the first NSTEMI.Conclusion More hypertension,diabetes,hyperlipidemia and higher levels of systolic blood pressure,lower levels of white blood cell and troponin Ⅰ were observed in women with the first NSTEMI.The long-term prognosis of female patients with NSTEMI is poor.And elevated levels of white blood cell and troponin-Ⅰ were the risk prognostic factors after PCI for women with the first NSTEMI.
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OBJECTIVE:To investigate the effects of loading-dose rosuvastain before early percutaneous coronary intervention (PCI) on reperfusion arrhythmias in patients with acute non-ST-segment elevation myocardial infarction (NSTEMI).METHODS:A total of 136 patients with NSTEMI were randomly divided into loading-dose group (68 cases) and control group (68 cases).Both groups who were not given anti-platelet drugs were given loading-dose of Aspirin enteric-coated tablets 300 mg+Clopidogrel sulfate tablets 600 mg immediately after admission.The patients who were given aspirin regularly were given loading-dose of Clopidogrel sulfate tablets 600 mg only once after admission.The patients who were given clopidogrel regularly were given loading-dose of Aspirin enteric-coated tablets 300 mg only once.Those received PCI 12-24 h after medication.After PCI,they took Aspirin enteric-coated tablets 100 mg for life+Clopidogrel bisulfate tablets 75 mg at least 12 months.Loading-dose group was given loading-dose of Rosuvastatin calcium tablets 20 mg orally,12 h before surgery.All patients began to take Rosuvastatin calcium tablets 10 mg,once a day,since the night after the operation.Coronary angiography and the occurrence of reperfusion arrhythmia were observed in 2 groups.The levels of CK-MB and cTnT,major adverse cardiovascular events (MACE) were observed before and after surgery.RESULTS:There was no statistical significance in the number of diseased vessels,culprit vessels,the degree of culprit vessels stenosis or the incidence of MACE between 2 groups (P＞ 0.05).The incidence of reperfusion arrhythmia in loading-dose group was significantly lower than control group,with statistical significance (P＜0.01).There was no statistical significance in the degree of culprit vessels stenosis between 2 groups (P＞0.05).Before surgery,there was no statistical significance in the levels of CK-MB or cTnT between 2 groups (P＞0.05).After surgery,the levels of CK-MB and cTnT in 2 groups were significantly higher than before surgery,but the loading-dose group was significantly lower than the control group,with statistical significance (P＜0.01).CONCLUSIONS:Preoperative loading-dose of rosuvastatin before PCI can reduce the incidence of reperfusion arrhythmias in NSTEMI patients.
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OBJECTIVE:To investigate the effects of intensive atorvastatin therapy on postoperative blood lipid,inflammation reaction and major adverse cardiac events (MACE) in non-ST segment elevation myocardial infarction (NSTEMI) patients before PCI.METHODS:A total of 120 NSTEMI patients underwent selective PCI were randomly divided into control group (60 cases) and observation group (60 cases).Both groups were given Aspirin enteric-coated tablet 0.3 g orally,once a day+Clopidogrel sulfate tablet 300 mg orally,once a day,immediately after admission.After operation,they were given medicine continuously for consecutive 12 weeks.Control group was given Atorvastatin calcium tablet 80 mg orally,immediately after operation,and then was given 40 mg,once a day,for consecutive 12 weeks.Observation group was additionally given Atorvastatin calcium tablet 40 mg orally 6 h before operation on the basis of control group.The levels of TG,TC,HDL-C,LDL-C,hs-CRP,TNF-αt and IL-10 before and after PCI,the incidence of postoperative MACE,postoperative re-hospitalization rate and the occurrence of ADR were observed in 2 groups.RESULTS:There was no statistical significance in the levels of TG,TC,HDL-C or LDL-C between 2 groups before and after operation (P＜0.05).After operation,the levels of hs-CRP,TNF-α and IL-10 in 2 groups were significantly higher than before operation,and the observation group was significantly lower than the control group,with statistical significance (P＜ 0.05).There was no statistical significance in the incidence of postoperative MACE,postoperative re-hospitalization rate or the incidence of ADR between 2 groups (P＞0.05).CONCLUSIONS:Intensive atorvastatin therapy before PCI can effectively reduce the levels of inflammatory response in NSTEMI patients,but have no significant changes in blood lipid levels and MACE risk,without increasing the incidence of ADR.
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Objective To investigate the effect of psychological intervention, Plavix, Aspirin Enteric-coated Tablets combined in the treatment of non ST segment elevation acute myocardial infarction. Methods 102 patients with non ST elevation acute myocardial infarction were selected in Taizhou Central Hospital from January 2015 to January 2017 and divided into study group (n=51) and control group (n=51) by single and double number (hospital admission order) method. The control group were treated with clopidogrel, Aspirin Enteric-coated Tablets, the study group on the basis of routine treatment, were given plavix, Aspirin Enteric-coated Tablets, comprehensive psychological intervention program. Results The total effective rate of the study group was 90.20%, and the total effective rate of the control group was only 70.59%, the difference was statistically significant (P<0.05). Conclusion The application of psychological intervention combined with plavix, Aspirin Enteric-coated Tablets treatment of non ST elevation acute myocardial infarction can significantly improve the clinical efficacy, to ensure the quality of life, life is of positive significance to safety.
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Objective To investigate the effect of psychological intervention, Plavix, Aspirin Enteric-coated Tablets combined in the treatment of non ST segment elevation acute myocardial infarction. Methods 102 patients with non ST elevation acute myocardial infarction were selected in Taizhou Central Hospital from January 2015 to January 2017 and divided into study group (n=51) and control group (n=51) by single and double number (hospital admission order) method. The control group were treated with clopidogrel, Aspirin Enteric-coated Tablets, the study group on the basis of routine treatment, were given plavix, Aspirin Enteric-coated Tablets, comprehensive psychological intervention program. Results The total effective rate of the study group was 90.20%, and the total effective rate of the control group was only 70.59%, the difference was statistically significant (P<0.05). Conclusion The application of psychological intervention combined with plavix, Aspirin Enteric-coated Tablets treatment of non ST elevation acute myocardial infarction can significantly improve the clinical efficacy, to ensure the quality of life, life is of positive significance to safety.
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Objective To investigate the effects of different anti thrombotic strategies on the risk of bleeding, cardiac events and quality of life in elderly patients with acute non ST segment elevation myocardial infarction.MethodsElderly patients with acute non ST elevation myocardial infarction 200 cases of complication in patients with atrial fibrillation, are in our hospital from May 2013 to December 2015 were cardiovascular department, after discharge according to different antithrombotic strategy, according to the 5 groups, including 40 cases of A group, 75mg/d+ 100mg/d treatment with clopidogrel and aspirin;B group 40 cases.Using warfarin therapy;40 cases in group C, 75mg/d or 100mg/d+ with clopidogrel aspirin warfarin therapy;40 cases in group D, using 75mg/d+ 100mg/d+clopidogrel aspirin warfarin therapy, group E received 75mg/d+ clopidogrel aspirin 100mg/d plus warfarin therapy, based on the use of psychological intervention.The risk of bleeding, cardiac events and quality of life scores were compared.ResultsStatistical analysis showed that the incidence of major cardiac events in E group (2.5%) and the quality of life were optimal (the data are statistically significant compared to P<0.05, A, B);C, D, E groups, the risk of major bleeding rate compared with no significant difference.ConclusionThe application of drugs and psychological intervention in the treatment of elderly patients with acute non ST segment elevation myocardial infarction patients can be more effective.
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Objective To investigate the relationship between admission blood glucose and in-hospital adverse events of elderly patients with non-ST-segment elevation myocardial infarction(NSTEMI) combined with multi-organ dysfunction in emergency department,and to assess the prognostic value.Methods Fifty-one geriatric patients with NSTEMI combined with multi-organ dysfunction were selected and divided into the experimental group (26 cases) and control group (25 cases),depending on whether they had adverse events in hospital.After the propensity score matching was used to reduce confounding effects,the difference in admission blood glucose between the two groups was compared.According to the ROC curve,the predictive value of immediate admission blood glucose to the incidence of adverse events during hospitalization was detected.Results After propensity score matching,admission blood glucose of the experimental group ((10.35±4.06) mmol/L) was higher than that of the control group ((7.05±2.45) mmol/L),and this difference was statistically significant (t=2.869,P<0.01).The area under the ROC curve for adverse events during hospitalization was 0.758 (P<0.01),and it may reach the best prognostic value when we choose 8.025mmol/L as the critical value.Under this condition,the sensitivity was 0.765 and specificity was 0.765.Conclusion For geriatric patients with NSTEMI combined with multi-organ dysfunction in emergency department,admission blood glucose is a risk factor for in-hospital adverse event,and the risk is high when admission blood glucose is over 8.025mmol/L.
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Objective To investigate the clinical significance of soluble CD40 ligand (sCD40L ) and lipoprotein associated phospholipase A2 (Lp-PLA2 ) in the assessment of coronary artery severity and risk classification in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods Of the 9 6 patients with coronary heart disease diagnosed by coronary angiography,2 8 patients had stable angina pectoris (SAP),38 patients unstable angina pectoris (UAP)and 30 patients acute non-ST-segment elevation myocardial infarction (NSTEMI).Another 30 patients with non-coronary heart disease (NC)served as controls.The sCD40L and Lp-PLA2 levels were determined by enzyme-linked immune sorbent assay (ELISA)method.The Gensini score was used to assess the severity of coronary artery and analyze the correlation with sCD40L and Lp-PLA2.The correlation of sCD40L and Lp-PLA2 with GRACE risk score was analyzed too.Results ① sCD40L was significantly higher in NSTEMI and UAP groups than in SAP and NC groups (P0 .0 5 )or SAP and NC groups (P>0 .0 5 ).Lp-PLA2 was significantly higher in NSTEMI group than in UAP,SAP and NC groups (P<0.05).Lp-PLA2 was significantly higher in UAP group than in SAP and NC groups (P<0.05).② We found that sCD40L had obvious correlation with Lp-PLA2 (r=0.284, P<0.01),Gensini score (r=0.213,P<0.05),and GRACE (r=0.224,P<0.05).Lp-PLA2 was significantly correlated with Gensini score (r=0.270,P<0.05),and GRACE (r=0.323,P<0.01).③ Multivariate logistic regression analysis showed that Lp-PLA2 was independently associated with NSTE-ACS (P<0.05).Conclusion The sCD40L and Lp-PLA2 which were significantly elevated in NSTE-ACS are correlated with the severity of coronary artery disease.The two indexes indicate the instability of atherosclerotic plaque;thus they can be used as predictors of risk assessment in coronary heart disease.
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OBJECTIVE:To evaluate the effects of loading-dose rosuvastatin on vascular endothelial function in patients with non-ST segment elevation acute coronary syndromes (NSTE-ACS) after early interventional therapy. METHODS:Totally of 128 NSTE-ACS patients underwent early interventional therapy were randomly divided into conventional dose group (63 cases) and loading dose group(65 cases). Before operation,all patients were given Clopidogrel sulfate tablets 300 mg and Aspirin enteric-coat-ed tablets 100 mg;on this basis,conventional dose group was given Rosuvastatin calcium tablets 10 mg orally;loading dose group was given Rosuvastatin calcium tablets 20 mg orally. After PCI,both groups were given Rosuvastatin calcium tablets 10 mg orally, qd,and Aspirin enteric-coated tablets(100 mg/d)and Clopidogrel sulfate tablets(75 mg/d),for consecutive 3 months. The blood samples were collected before surgery,8 h and 24 h after surgery. The serum levels of CK-MB,cTn T,hs-CRP,ET and NO were detected. The occurrence of major adverse cardiovascular events was recorded within 3 months after surgery. RESULTS:Compared with before surgery,the serum levels of CK-MB,cTn T,hs-CRP and ET were increased significantly 8 h and 24 h after surgery, while the level of NO was decreased,with statistical significance (P0.05). CONCLUSIONS:For NSTE-ACS patients underwent ear-ly interventional therapy,loading dose of rosuvastatin can protect the patients and inhibit the injury of vascular endothelial cell in-duced by the surgery.
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Objective:To investigate the clinical value of electrocardiogram in risk stratification of patients with non-ST segment elevation acute coronary syndrome(ACS).Methods: According to the change of electrocardiogram, 260 patients with non-ST segment elevation ACS were divided into four groups: ECG-undiagnosed group (n=22), T-wave inversion group (ST-segment depression group), ST-segment depression group (n=118) and normal electrocardiogram group(n=80). All patients were treated with conventional 18-lead electrocardiogram and troponin I(TnI)detection in the four groups. The incidence of cardiovascular events during and after hospitalization was observed. Results: The complex cardiovascular events and recurrent angina attacks in ST segment depression group increased significantly than that in normal ECG group. The difference was statistically significant (x2=5.723,x2=15.680;P<0.05). Multivariate logistic regression analysis showed that TnI positive factors predict the independent value of composite cardiovascular events higher.Conclusion:The patients with ST segment elevation acute coronary syndrome can effectively carry out risk stratification by ECG ST-segment changes and TnI levels, and predict the cardiovascular events. It has higher clinical application value and independent predictive value of TnI positive.