Effects of the COVID-19 pandemic on reperfusion therapy for acute ischemic stroke patients in Huizhou City, China.

BACKGROUND AND PURPOSE: The COVID-19 pandemic has impacted the reperfusion therapy for acute ischemic stroke (AIS) patients. Huizhou City utilized its experience with the SARS and MERS breakouts to establish a reperfusion treatment program for AIS patients. METHOD: This is a retrospective study on 8 certified stroke hospitals in Huizhou City from January 2020 to May 2020. We analyzed the number of AIS patients with reperfusion therapy, stroke type (anterior/posterior circulation stroke), modes of transport to hospital, NIHSS score, onset to door time (ODT), door to needle time (DNT), and door to puncture time (DPT). The analysis was compared with baseline data from the same time period in 2019. RESULT: In 2020, the number of AIS patients receiving reperfusion therapy decreased (315 vs. 377), NIHSS score increased [8 (4, 15) vs. 7 [ (1, 2)], P = 0.024], ODT increased [126 (67.5, 210.0) vs. 120.0 (64.0, 179.0), P = 0.032], and DNT decreased [40 (32.5, 55) vs. 48 (36, 59), P = 0.003]. DPT did not change. Seventy percent of AIS patients indicated self-visit as their main mode of transport to the hospital. In both periods, mild stroke patients were more likely to self-visit than utilize emergency systems [2019: 152 (57.6%) vs. 20 (45.6%), P = 0.034; 2020: 123 (56.9%) vs. 5 (14.7%), P < 0.001]. The NIHSS score for self-visiting patients was lower for patients who utilized the ambulance system in both years [self-visit: 6.00 (3.00, 12.00), ambulance: 14.00 (9.00, 19.00), P < 0.001]. The volume of reperfusion patients was lower in 2020; however, the decrease was only significant (P = 0.028) in February 2020. CONCLUSION: During the COVID-19 pandemic in 2020, the number of AIS patients receiving reperfusion therapy significantly decreased when compared to the same period in 2019. The patients' condition increased severity, ODT increased, and the DNT decreased. DPT was not significant for self-visiting and ambulance patients. Moderate to severe stroke patients were more likely to utilize ambulance services.

Rectification of chiral active particles driven by transversal temperature difference.

Rectification of chiral active particles driven by transversal temperature difference is investigated in a two-dimensional periodic channel. Chiral active particles can be rectified by transversal temperature difference. Transport behaviors are qualitatively different for different wall boundary conditions. For the sliding boundary condition, the direction of transport completely depends on the chirality of particles. The average velocity is a peaked function of angular velocity or temperature difference. The average velocity increases linearly with the self-propulsion speed, while it decreases monotonically with the increase in the packing fraction. For randomized boundary condition, the transport behaviors become complex. When self-propulsion speed is small, in contrast with the sliding boundary condition, particles move in the opposite direction. However, for large self-propulsion speed, current reversals can occur by continuously changing the system parameters (angular velocity, temperature difference, packing fraction, and width of the channel).

Comparison of Ticagrelor with Clopidogrel in Reducing Interleukin-17 and Myeloperoxidase Expression in Thrombus and Improving Postprocedural Coronary Flow in ST-segment Elevation Myocardial Infarction Patients.

PURPOSE: This study aimed to explore the effects of ticagrelor (a P2Y12 receptor inhibitor) on interleukin (IL)-17 and myeloperoxidase (MPO) expression in coronary thrombus as well as on the coronary blood flow in ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI). METHODS: Forty STEMI patients who were admitted to the First Affiliated Hospital of Harbin Medical University between August 1, 2014 and December 30, 2014 were enrolled in this study according to a set inclusion criteria. They were randomized to ticagrelor and clopidogrel groups and treated with 180 mg ticagrelor and 600 mg clopidogrel before PCI, respectively. Intracoronary thrombus aspiration was performed by a physician during PCI. Immunohistochemistry and Western blot analysis were carried out to detect the expression of IL-17 and MPO in the thrombus. Corrected thrombolysis in myocardial infarction frame count (CTFC) was used to evaluate blood flow after PCI. RESULTS: Immunohistochemistry results showed that the average positive staining area percentage of IL-17 and MPO in the clopidogrel group was significantly higher than that in the ticagrelor group. Western blot analysis also showed similar results for IL-17 (clopidogrel 0.71 ± 0.036, ticagrelor 0.50 ± 0.56) and MPO (clopidogrel 0.50 ± 0.040; ticagrelor 0.38 ± 0.06). CTFC was lower in the ticagrelor group than that in the clopidogrel group (P < 0.05). CONCLUSIONS: Ticagrelor is more effective than clopidogrel in reducing inflammation thrombosis and improving postprocedural PCI blood flow in STEMI patients. This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page.

miRNA-21 Expression in the Serum of Elderly Patients with Acute Myocardial Infarction.

BACKGROUND The aims of this study were to examine the expression of miRNA-21 in the serum of elderly patients (>65 years) with acute myocardial infarction (AMI) and to investigate the potential role of serum miRNA-21 as a marker of early cardiac myocyte damage. MATERIAL AND METHODS Thirty-eight elderly patients with recent AMI, 27 elderly patients with unstable angina pectoris, and 25 healthy elderly individuals were included in the study. Serum miRNA-21 expression was determined following total RNA extraction and reverse-transcribed into cDNA, followed by reverse transcription-polymerase chain reaction (RT-PCR). Serum creatine kinase MB isoenzyme (CK-MB) and cardiac troponin I (cTnI) levels were analyzed by electrochemiluminescence. Apoptosis of human cardiac myocytes (HCM) was analyzed using fluorescence-activated cell sorting (FACS), and protein expression of caspase-3 was detected using Western blot. RESULTS Expression levels of miRNA-21 in the serum of elderly patients with AMI were positively correlated with serum levels of CK-MB (r=0.3683, P=0.0229) and cTnI (r=0.5128, P=0.009). Following tumor necrosis factor (TNF)-α induction, the apoptosis rates of HCM transfected with the miRNA-21 mimic short hairpin RNA (shRNA) were downregulated by 39.1% compared with control HCM cells, and protein expression of c-Jun N-terminal kinases (JNK) and p38 were unchanged (P>0.05); protein expression of p-JNK, p-p38 and caspase-3 were downregulated by 37.1%, 35.8%, and 36.0%, respectively. CONCLUSIONS Expression of miRNA-21 was upregulated in the serum of elderly patients with AMI, which inhibited TNF-a induced apoptosis in HCM by activating the JNK/p38/caspase-3 signaling pathway.

Circulating microRNA-1 as a potential novel biomarker for acute myocardial infarction.

Recent studies have revealed the role of microRNAs (miRNAs) in a variety of basic biological and pathological processes and the association of miRNA signatures with human diseases. Circulating miRNAs have been proposed as sensitive and informative biomarkers for multiple cancers diagnosis. We have previously documented aberrant up-regulation of miR-1 expression in ischemic myocardium and the consequent slowing of cardiac conduction. However, whether miR-1 could be a biomarker for predicting acute myocardial infarction (AMI) is unclear. In the present study, we recruited 159 patients with or without AMI for quantification of miR-1 level in plasma using real-time RT-PCR method. We performed Wilcoxon rank sum and signed rank tests for comparison. Univariable linear regression and logistics regression analyses were performed to assess the potential correlation between miR-1 and known AMI markers. We also conducted receiver-operator characteristic curve (ROC) analysis to evaluate the diagnostic ability of miR-1. We found that: miR-1 level was significantly higher in plasma from AMI patients compared with non-AMI subjects and the level was dropped to normal on discharge following medication. Increased circulating miR-1 was not associated with age, gender, blood pressure, diabetes mellitus or the established biomarkers for AMI. However, miR-1 level was well correlated with QRS by both univariable linear and logistics regression analyses. The area under ROC curve (AUC) was 0.7740 for separation between non-AMI and AMI patients and 0.8522 for separation AMI patients under hospitalization and discharge. Collectively, our results revealed that circulating miR-1 may be a novel, independent biomarker for diagnosis of AMI.

[Outcome of patients with ST-elevation myocardial infarction complicated by pre-hospital cardiac arrest underwent emergency percutaneous coronary intervention].

OBJECTIVE: To evaluate the outcome of ST-elevation acute myocardial infarction (STEMI) patients complicated pre-hospital cardiac arrest underwent percutaneous coronary intervention (PCI). METHODS: From September 2004 to November 2008, 1446 consecutive patients with acute STEMI underwent PCI in our department. 49 out of 1446 patients complicated by pre-hospital cardiac arrest. Clinical outcome including total mortality, adverse cardiac events, stroke and bleeding events during the hospitalization period and within 1 year after discharge was compared between patients with or without pre-hospital cardiac arrest. RESULTS: PCI success rate was similar (85.7% vs. 88.8%, P = 0.497) while the incidence of in-hospital cardiogenic shock 22.4% vs. 3.0%, P < 0.001 and cardiac arrest (44.9% vs. 5.9%, P < 0.001) and in-hospital mortality (36.7% vs. 2.0%, P < 0.001) were significantly higher in patients with pre-hospital cardiac arrest than patients without pre-hospital cardiac arrest. Time from symptom onset to emergency treatment, asystole as initial rhythm, Glasgow coma scale (GCS ≤ 7) and cardiogenic shock on admission were independent risk factors of in-hospital death in patients with pre-hospital cardiac arrest. During follow up, incidences of overall mortality, re-infarction, revascularization and stroke were similar between the two groups. CONCLUSIONS: STEMI patients with pre-hospital cardiac arrest undergoing emergency PCI are facing higher risk of cardiogenic shock and cardiac arrest and higher in-hospital mortality compared to those without pre-hospital cardiac arrest. However, the post-hospital discharge outcome was similar between the two groups.

Hypermethylation of miR-181b in monocytes is associated with coronary artery disease and promotes M1 polarized phenotype via PIAS1-KLF4 axis.

BACKGROUND: Dysregulated microRNAs are involved in the macrophage polarization and atherosclerotic development. Apart from microRNAs, alteration in DNA methylation is considered as one of the most frequent epigenetic changes. The purpose of the research is to investigate the altered methylation status of miR-181b in the circulating monocytes from patients with coronary artery disease (CAD) and explore the underlying mechanisms. METHODS: We examined the methylation status of miR-181b in purified circulating monocytes from patients with CAD and healthy controls. We then transfected monocytes with miR-181b mimics and determined the role of miR-181b on the phenotypic switch of macrophages and inflammatory response. DNA methylation levels determined by MethyLight PCR and pyrosequencing at the promoter of miR-181b significantly increased in CAD patients. Based on TargetScan database, we identified PIAS1 as the target gene of miR-181b and explored the interaction of miR-181b and PIAS1 by Dual-Luciferase assay, quantitative PCR and immunoblots. We also investigated the role of miR-181b and PIAS1 on macrophage polarization and inflammation. RESULTS: Hypermethylation at the promoter of miR-181b directly contributed to the decrease of miR-181b activity and expression. Overexpression of miR-181b reduced M1 polarization and facilitated M2 polarization determined by quantitative PCR. While knockdown of PIAS1 induced KLF4 degradation and SUMOylation in monocytes, miR-181b mimics reverse the KLF4 SUMOylation via suppression of PIAS1. Moreover, KLF4 SUMOylation by PIAS1 reversed M1 polarization induced by depletion of miR-181b in monocytes. CONCLUSIONS: Hypermethylation of miR-181b induces M1 polarization and promotes atherosclerosis through activation of PIAS1 and KLF4 SUMOylation in macrophages.

Effect of atorvastatin on expression of IL-10 and TNF-alpha mRNA in myocardial ischemia-reperfusion injury in rats.

Myocardial ischemia and reperfusion (MI/R) is associated with an intense inflammatory reaction, which may lead to myocyte injury. Because statins protect the myocardium against ischemia-reperfusion injury via a mechanism unrelated to cholesterol lowering, we hypothesized that the protective effect of statins was related to the expression of TNF-alpha (TNF-alpha) and interleukin-10 (IL-10) mRNA. Seventy-two rats were randomly divided into three groups as follows: sham, I/R and I/R+atorvastatin. Atorvastatin (20 mg kg(-1)day(-1)) treatment was administered daily via oral gavage to rats for 2, 7 or 14 days. Ischemia was induced via a 30-min coronary occlusion. Reperfusion was allowed until 2, 7 or 14 days while atorvastatin treatment continued. We measured infarct size, hemodynamics and the plasma levels and the mRNA expression of TNF-alpha and IL-10 in the three groups. We demonstrated that the up-regulation of expression of both TNF-alpha mRNA and IL-10 mRNA was associated the increased plasma levels of TNF-alpha and IL-10 in the ischemic and reperfused myocardium compared with that in the sham group (P<0.01). Atorvastatin treatment prevented ischemia-reperfusion-induced up-regulation of both TNF-alpha and IL-10 mRNA, and improved left ventricular function (P<0.01). Our findings suggested that atorvastatin may attenuate MI/R and better recovery of left ventricle function following ischemia and reperfusion and IL-10 was not directly likely involved in this protective mechanism.

The 223A>G polymorphism of the leptin receptor gene and lipid-lowering efficacy of simvastatin in Chinese patients with coronary heart disease.

OBJECTIVE: To investigate whether leptin receptor (LEPR) 223A>G polymorphism influences serum lipid levels and whether this polymorphism affects the effectiveness of simvastatin in Chinese patients with coronary heart disease (CHD). METHODS: A total of 312 patients with CHD were treated with simvastatin 20 mg/day. Fasting serum lipids were determined before and after 12 weeks of treatment. RESULTS: Patients with AA genotype had significantly higher total cholesterol (TC) levels and lower high-density lipoprotein cholesterol (HDL-C) levels than those with GG genotype (P < 0.05) before simvastatin treatment. In addition, the ability of simvastatin to increase HDL-C levels was significantly lower in patients with AA genotype than those with GG genotype (P < 0.05). CONCLUSIONS: The 223A>G polymorphism of LEPR significantly modulates the HDL-C response to simvastatin in Chinese patients with CHD.

Effect of R219K polymorphism of the ABCA1 gene on the lipid-lowering effect of pravastatin in Chinese patients with coronary heart disease.

1. In the present study, we investigated the effects of the R219K polymorphism of the ATP-binding cassette transporter A1 (ABCA1) gene on serum lipid levels and the response to statin therapy in Chinese patients with coronary heart disease (CHD). 2. The study population consisted of 365 patients with CHD and 246 control subjects without signs or symptoms of CHD. Patients with CHD were treated with 20 mg/day pravastatin. Fasting serum lipids were determined before and after 12 weeks of treatment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). 3. The R219K polymorphism of the ABCA1 gene was not significantly associated with CHD (P > 0.05). Compared with controls, patients with the RR genotype had significantly higher serum triglyceride levels and lower high-density lipoprotein-cholesterol (HDL-C) levels than those with the KK genotype (P < 0.05). In addition, the effects of pravastatin in increasing HDL-C levels were significantly greater in patients with the KK genotype compared with those with the RR genotype (P < 0.05). 4. In conclusion, the R219K polymorphism of ABCA1 was associated with altered lipoprotein levels and the R219K variant significantly modulated the HDL-C response to pravastatin in Chinese patients with CHD.

[Intensive atorvastatin therapy in patients with acute myocardial infarction].

OBJECTIVE: To assess the safety and efficacy of 40 mg daily atorvastatin in patients with acute myocardial infarction. METHODS: A total of 1102 patients with AMI admitted to our hospital from 2003 to 2007 were assigned to atorvastatin 40 mg daily within 24 hours of hospitalization and continued till 3 months post discharge. Patients with LDL-C < 2.0 mmol/L or increased liver enzyme level (3 times higher than normal) at discharge received atorvastatin 20 mg daily. Lipid profiles, high-sensitivity C-reactive protein, liver enzyme level were measured at admission, hospital discharge and 3 months after discharge. RESULTS: (1)The mean hospitalization duration was (10.17 +/- 1.83) days. LDL-C was continuously decreased [(3.24 +/- 1.04) mmol/L at admission, (2.27 +/- 2.00) mmol/L at discharge and (1.48 +/- 0.78) mmol/L at 3 months after discharge, all P < 0.05]. HDL-C decreased from (1.45 +/- 0.38) mmol/L to (1.20 +/- 0.30) mmol/L at hospital discharge, then increased to (1.65 +/- 1.79) mmol/L at 3 months after hospital discharge (all P < 0.05). TC and apoB were also significantly decreased from admission to discharge (all P < 0.05). (2) high-sensitivity C-reactive protein level significantly decreased from admission to hospital discharge and at 1 months after hospital discharge [(49.71 +/- 50.46) mg/L vs. (8.80 +/- 17.66) mg/L vs. (2.61 +/- 2.30) mg/L, all P < 0.05]. (3) Increased ALT > 120 U/L (3 times higher than normal) were found in 127(11.25%), AST > 120 U/L were found in 26(2.40%) patients at discharge. There were still 4 patients with increased ALT (> 120 U/L) at 1 months after discharge and all returned to normal at 3 months after discharge. CONCLUSION: Intensive atorvastatin therapy with a dose of 40 mg daily is safe and effective for patients with AMI.

[Efficacy of the thrombectomy on no-reflow in patients with acute myocardial infarction].

OBJECTIVE: To study the efficacy of the percutaneous thrombectomy on no-reflow in the patients with acute myocardial infarction (AMI) with angiographically proven thrombus. METHODS: A total of 68 patients suffering from AMI with coronary thrombus shown by angiography were randomly divided into a group of percutaneous coronary intervention (PCI) therapy (n = 34) and a group of PCI plus percutaneous thrombectomy (n = 34). At 24 hours and 1 week after PCI, real-time imaging was performed by contrast pulse sequencing technology. Contrast score index (CSI), regional wall motion score index (WMSI), endocardial length of contrast defect (CDL) and wall motion abnormality (WML) were calculated. RESULTS: In patients treated with a percutaneous thrombectomy, CSI, WMSI, CDL/left ventricular length (LV), and WML/LV were significantly lower than in PCI group at both time points of observation, and these indexes were markedly decreased at 1 week after PCI compared with 24 hours after PCI (P<0.05 or P<0.01). CONCLUSION: The beneficial effect of the thrombectomy occurs at the microvascular level. Thrombectomy reduces the no-flow phenomenon and the extent of microvascular obstruction, thus it is a feasible therapy in patients with AMI.

[The prognostic value of hyponatremia in patients with acute myocardial infarction].

OBJECTIVE: To evaluate the prognostic significance of hyponatremia in patients with AMI. METHODS: The study population consisted of 670 patients with AMI in coronary care unit in our hospital from January 2003 to December 2004. The patients were designed into three groups according to serum sodium concentration within twenty four to forty eight hours following the onset of AMI: Group A. Na(+) > or = 135 mmol/L; Group B. Na(+) 120-135 mmol/L; Group C. Na(+) < or = 120 mmol/L. The data of myocardial enzymes, myocardial infarction size, heart function and inhospital mortality were analyzed retrospectively. RESULTS: 1. The inhospital mortality of each group: group A was 7.6% (17/225), group B was 8.1% (34/421), group C was 33.3% (8/24). The difference between group C and group B or group A was significant. The P value was little than 0.05. 2. Activities of serum creatine phosphatase kinase and serum creatine phosphatase kinase isoenzymes and myocardial infarction sizes in each group were different (P < 0.05). 3. 59 cases of all died and 611 cases of all recovered in duration of hospital stay. Serum sodium concentrations of the recovered group were (133.00 +/- 5.25) mmol/L, and that of the died group were (122.00 +/- 7.25) mmol/L (P < 0.01). 4. In a multivariate logistic regression analysis, hyponatremia was associated with 30-day mortality in patients with AMI. In analysis of the association between the degree of hyponatremia and outcome, we observed that the risk of 30-day mortality increased with the severity of hyponatremia. CONCLUSION: Hyponatremia may be one of the important markers that predict a worse prognosis in patients with AMI.

Application of neutrophil/lymphocyte ratio in predicting coronary blood flow and mortality in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.

BACKGROUND: To investigate the potential correlation of neutrophil/lymphocyte ratio (NLR) to coronary blood flow and in-hospital along with long-term mortality in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS: In the current study, 636 consecutive patients with STEMI were recruited and stratified into three tertiles by NLRs upon admission (tertile I<3.0, tertile II 3.0-6.40, tertile III>6.40). The coronary blood flow was expressed by corrected TIMI frame count (CTFC). The in-hospital mortality and 12-month long follow-up data were collected. Receiver operating characteristic (ROC) curves were also constructed. RESULTS: Our analysis demonstrated that NLR was positively correlated to CTFC and in-hospital mortality (r=0.517, p<0.001; r=0.439, p<0.001). In the multiple logistic regression analysis, NLR was testified as an independent risk factor for coronary blood flow after PCI and in-hospital mortality [odds ratio (OR)=2.031, 95% confidence interval (CI): 1.627-2.435, p<0.001; OR=1.176, 95% CI: 1.025-1.351, p=0.021]. During the 12-month follow-up, there were a total of 43 deaths and statistically significant increase in long-term mortality was observed in patients from tertile I to III (p=0.005). In the ROC curves analysis, the area under the curve (AUC=0.607, 95% CI: 0.475-0.739, p=0.253), with threshold value of 5.9 (sensitivity: 63.7%, specificity: 61.1%) for predicting in-hospital mortality. CONCLUSIONS: NLR, an indicator that can be tested in the laboratory with low cost and time consumption, is independently correlated to coronary blood flow and acts as an independent risk factor for in-hospital mortality in patients with STEMI undergoing PCI.

Effect of thoracic epidural blockade on plasma fibrinogen levels in patients with dilated cardiomyopathy.

OBJECTIVE: To investigate the effects of thoracic epidural blockade (TEB) on plasma fibrinogen (FIB) levels. METHODS: Thirty cases of dilated cardiomyopathy (DCM) were selected randomly into a TEB group and a control group. TEB patients were subjected to a persistent TEB (T1 - 5), and injected with 0.5% lidocaine 3 - 5 ml every two or four hours for four weeks in addition to routine medicine, while patients in the control group were given routine medicine only. Plasma concentrations of FIB were measured using the micro-capillary assay. Doppler echocardiography was performed before and after the treatment. RESULTS: Plasma concentrations of FIB in two groups were greater than the normal value before the treatment. There was a significant decrease of plasma concentrations of FIB in the TEB group after the treatment (4.2 +/- 1.3 g/L vs 3.6 +/- 0.9 g/L, P < 0.05), but there was no significant change in the control group (4.2 +/- 1.2 g/L vs 4.3 +/- 1.9 g/L, P > 0.05). After four weeks of treatment, the left ventricular end diastolic diameters (LVEDD) of TEB patients were reduced (72 +/- 10 mm vs 69 +/- 10 mm, P < 0.05) and the left ventricular ejection fraction (LVEF) of TEB patients increased significantly (33% +/- 13% vs 44% +/- 14%, P < 0.05). In contrast, LVEDD (73 +/- 11 mm vs 73 +/- 12 mm, P > 0.05) and LVEF (32% +/- 14% vs 33% +/- 12%, P > 0.05) did not change significantly in the control group. CONCLUSIONS: The results suggest that plasma FIB levels in patients with DCM were decreased by performing a TEB, in addition to a reduction of the enlarged cardiac cavity and an improvement in cardiac systolic dysfunction. TEB might contribute to lowering the occurrence of thrombus and thromboembolism in patients with DCM. TEB might be a promising therapeutic method to improve the prognosis of DCM patients.

Effect of spironolactone on cardiac remodeling after acute myocardial infarction.

BACKGROUND: Few studies have reported the effect of aldosterone receptor antagonist (ARA) on myocardial remodeling after acute myocardial infarction (AMI). This study was undertaken to investigate the preventive effect of ARA on myocardial remodeling after AMI. METHODS: A total of 616 patients who had been admitted into the CCU of the First Affiliated Hospital of Harbin Medical University from January 2008 to January 2010 were studied prospectively. Only 528 patients were observed completely, including 266 of the control group and 262 of the treatment group. There was no statistical difference in age, gender, medical history, admission situation, and treatment between the two groups (P>0.05). The preventive effects of spironolactone on cardiac remodeling, left ventricular function, renal function and blood levels of potassium were evaluated by echocardiography, serum potassium and serum creatinine at one-month and one-year follow-up. RESULTS: The echocardiography indicators such as LVESD, LVEDD, LVEF, LAD-ML and LAD-SI were significantly improved in the treatment group compared with the control group at one year (P<0.05). In the treatment group, LVESD, LVEDD, LVPWT, LVEF, LAD-ML and LAD-SI were more significantly improved at one year than one month (P<0.05, P=0.007 to LVEF), and in the control group LVEF was more significantly improved at one year than one month (P=0.0277). There were no significant differences in serum potassium and serum creatinine levels between the two groups. CONCLUSION: On the basis of conventional treatment, the early combination of low-dose spironolactone (20 mg/d) could inhibit cardiac remodeling at late stage and prevent heart failure.

Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest.

BACKGROUND: Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events. METHODS: A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke. RESULTS: Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P < 0.05) and a faster heart rate (P < 0.05), and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤ 7 on admission (P < 0.001). And the in-hospital mortality was higher in the OHCA patients (55.6% vs. 2.4%, P < 0.001). Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS ≤ 7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization (P < 0.001, P < 0.05). And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs. 84.3%, P < 0.001). CONCLUSIONS: During hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

Effect of percutaneous thrombectomy on echocardiographic measures of myocardial microcirculation in elderly patients with acute myocardial infarction.

OBJECTIVES: To study the efficacy of percutaneous thrombectomy (PT) in improving myocardial microcirculation in elderly acute myocardial infarction (AMI) patients. METHODS: A total of 104 patients (> or = 65 years) with AMI and coronary thrombus shown by angiography were randomly divided into a group of percutaneous coronary intervention (PCI) (n=52) and a group of PCI plus PT (n=52). At 24 h and 1 week after PCI, real-time myocardial contrast echocardiography was performed by contrast pulse sequencing technology. Contrast score index, contrast defect length/left ventricle length [CDL/LVL (%)], wall motion score index and wall motion abnormal length/LVL (%) were calculated. RESULTS: At each time point, in patients treated with PCI plus PT, contrast score index, CDL/LVL (%), wall motion score index and wall motion abnormal length/LVL (%) were significantly lower than that in the PCI group. CONCLUSION: Thrombectomy reduces the noreflow and the extent of microvascular obstruction, thus it was a feasible therapy in elderly patients with AMI.

Comparison of effects of simvastatin versus atorvastatin on oxidative stress in patients with coronary heart disease.

BACKGROUND: HMG-CoA reductase inhibitors (statins) have antiatherogenic effects beyond their cholesterol-lowing effect. Whether atorvastatin has a stronger antioxidant effect than other statins is uncertain. HYPOTHESIS: To determine the effects of simvastatin and atorvastatin on markers of oxidative stress in patients with coronary heart disease (CHD). METHODS: This study was comprised of 164 patients with CHD and a control population of 122 healthy subjects. The patients with CHD were divided into 2 groups and treated with either simvastatin 20 mg/day or atorvastatin 10 mg/day. The markers of oxidative stress were measured before and after 12 weeks of treatment. RESULTS: The effects of atorvastatin on reducing oxidative stress were significantly greater compared with those of simvastatin (P < 0.05). The changes in the markers of oxidative stress did not correlate with the changes in the plasma lipid profile (P > 0.05). CONCLUSIONS: This study suggests that atorvastatin reduces oxidative stress more effectively than simvastatin.