Caracterización del infarto agudo de miocardio con elevación del segmento st en pacientes atendidos en un centro de referencia. Periodo 2021-2023

Introducción: el riesgo de aparición del infarto agudo de miocardio está relacionada con varias comorbilidades, muchas de las cuales son prevenibles y tratables. El infarto agudo de miocardio tiene un impacto relevante en términos de mortalidad y número de hospitalizaciones. Objetivos: determinar las características clínica-epidemiológicas del infarto agudo de miocardio con elevación del segmento ST en pacientes atendidos en el Centro Médico Nacional-Hospital Nacional, durante el periodo 2021-2023. Metodología: el diseño del estudio fue observacional, descriptivo de corte transversal, sobre las características clínica-epidemiológicas del infarto agudo de miocardio con elevación del segmento ST en pacientes mayores de edad atendidos en el Centro Médico Nacional-Hospital Nacional, durante el periodo 2021-2023. Resultados: se analizaron 102 expedientes de pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST con una media de 64 ± 12 años; el 68 % (n = 69) correspondió al sexo masculino, con una edad promedio de 62 años, y en relación a las mujeres el promedio fue de 64 años. El motivo de consulta principal fue el dolor precordial y la cara miocárdica más afectada de acuerdo con el electrocardiograma inicial fue la cara anteroseptal. La mortalidad intrahospitalaria fue del 16 %, el 68 % correspondió a varones. La comorbilidad más frecuente fue la hipertensión arterial. Conclusión: La hipertensión arterial es la patología más prevalente. Asimismo, son habituales la obesidad, el tabaquismo y la diabetes mellitus. Las comorbilidades están en relación directa con la edad y prevalecen en mayores de 60 años. El infarto agudo de miocardio con elevación del segmento ST es más frecuente en el sexo masculino.

Introduction: the risk of acute myocardial infarction is related to several comorbidities, many of which are preventable and treatable. Acute myocardial infarction has a relevant impact in terms of mortality and number of hospitalizations. Objectives: the design of the study was observational, descriptive, cross-sectional, on the clinical characteristics of ST-segment elevation myocardial infarction, in adult patients treated at the Centro Médico Nacional-Hospital Nacional, during the period 2021-2023. Methodology: the design of the study was observational, descriptive, cross-sectional, on the clinical-epidemiological characteristics of acute myocardial infarction with ST segment elevation in adult patients treated at the National Medical Center-National Hospital, during the period 2021-2023. Results: 102 records of patients with a diagnosis of ST-segment elevation myocardial infarction with a mean age of 64 ± 12 years were analyzed; 68 % (n = 69) were male, with an average age of 62 years, and in relation to women the average was 64 years. The main reason for consultation was precordial pain and the most affected myocardial aspect according to the initial electrocardiogram was the anteroseptal aspect. In-hospital mortality was 16 %, 68 % of which were men. The most frequent comorbidity was arterial hypertension. Conclusion: high blood pressure is the most prevalent pathology. Likewise, obesity, smoking and diabetes mellitus are common. Comorbidities are directly related to age and prevail in those over 60 years of age. ST-segment elevation myocardial infarction is more common in males.

Profile of Notifications of Deaths Due to Acute Myocardial Infarction in the I GERES Municipalities of Pernambuco, 2018-2021 / Perfil das Notificações das Mortes por Infarto Agudo do Miocárdio nos Municípios da I GERES de Pernambuco, 2018-2021

In Brazil and around the world, cardiovascular diseases are responsible for thousands of deaths every year. Among these, those related to ischemic heart disease stand out. From this perspective, to assist in the development of effective and timely health strategies and policies, this study aimed to analyze deaths from Acute Myocardial Infarction (AMI) reported in municipalities belonging to the I Regional Health Management (GERES) of Pernambuco in the years 2018 to 2021. This is a retrospective ecological study, carried out using data from the Mortality Information System. The variables used to describe deaths from AMI were: municipality of coverage, sex, age, color/race, education, marital status and place of death. The results showed a reduction in deaths due to heart attacks in the municipalities and years investigated. The variables studied showed a statistically significant association with the rates of deaths from AMI. The predominant profile of deaths from heart attacks was among residents of the reef, male, mixed race, with one to three years of education, aged 75 and over and married. This study makes important contributions by describing the profile of deaths due to AMI in the I GERES municipalities of Pernambuco and can help guide public health strategies. (AU)

No Brasil e no Mundo, as doenças cardiovasculares são responsáveis por milhares de mortes todos os anos. Entre tais, destacam-se aqueles relacionados à doença isquêmica do coração. Nesta perspectiva, para auxiliar na elaboração de estratégias e políticas de saúde eficazes e oportunas, este estudo teve como objetivo analisar as mortes por Infarto Agudo do Miocárdio notificadas nos municípios pertencentes à I Gerência Regional de Saúde (GERES) de Pernambuco nos anos de 2018 a 2021. Trata-se de um estudo ecológico retrospectivo, realizado através de dados do Sistema de Informação de Mortalidade. A variáveis utilizadas para a descrição das mortes por IAM foram: município de abrangência, sexo, idade, cor/raça, escolaridade, estado civil e local de ocorrência do óbito. Os resultados mostraram redução dos óbitos por Infarto nos municípios e anos investigados. As variáveis estudadas apresentaram associação estatisticamente significativa com as taxas de mortes por IAM. O perfil predominante das mortes por infarto foi entre os residentes do recife, sexo masculino, pardos, escolaridade de um a três anos, com faixa etária de 75 anos e mais e com estado civil casado. Este estudo traz contribuições importantes ao descrever o perfil dos óbitos por IAM nos municípios da I GERES de Pernambuco, podendo auxiliar no direcionamento de estratégias em saúde pública. (AU)

Effects of alfentanil on myocardial fibrosis in rats with acute myocardial infarction by regulating the SphK1/S1P signaling pathway / 中国药房

OBJECTIVE To explore the effects of alfentanil （ALF） on myocardial fibrosis in rats with acute myocardial infarction （AMI） by regulating sphingosine kinase 1 （SphK1）/sphingosine 1-phosphate （S1P） signaling pathway. METHODS Male SD rats were collected to construct AMI model by the ligation of anterior descending branch of left coronary artery. The successfully modeled rats were randomly divided into AMI model group （Model group）， ALF low-dose group （ALF-L group， 0.25 mg/kg ALF）， ALF high-dose group （ALF-H group， 0.5 mg/kg ALF）， high dose of ALF+SphK1 activator group （ALF-H+K6PC-5 group， 0.5 mg/kg ALF+1 μg/g K6PC-5）. At the same time， a sham operation group （Sham group） was set up to perform only chest opening/closing operations without ligating the anterior descending branch of left coronary artery， with 15 rats in each group. Rats in each drug group were intraperitoneally injected with the corresponding drug solution， once a day， for 4 consecutive weeks. Twelve hours after the last medication， cardiac function indicators [left ventricular systolic pressure （LVSP）， left ventricular ejection fraction （LVEF）， left ventricular systolic diameter （LVSD）， left ventricular fractional shortening （LVFS）] of rats were detected in each group； the condition of myocardial infarction， pathological changes in myocardial tissue， and degree of fibrosis were observed； serum levels of brain natriuretic peptide （BNP） and cardiac troponin Ⅰ （cTnⅠ） in rats were detected. The protein expressions of collagen Ⅰ ， collagen Ⅲ ， matrix metalloproteinase-2 （MMP-2）， SphK1 and S1P were alsodetected in the myocardial tissue of rats. RESULTS Compared with the Sham group， the arrangement of myocardial cells in the Model group was disordered， with a large number of inflammatory cells infiltrating. The levels of LVSP， LVFS and LVEF in the Model group were significantly reduced （P＜0.05）； LVSD level， myocardial infarction area， collagen volume fraction， serum levels of BNP and cTnⅠ， the protein expressions of collagen Ⅰ， collagen Ⅲ， MMP-2， SphK1 and S1P in myocardial tissue were significantly increased or enlarged （P＜0.05）. Compared with the Model group， the pathological changes and degree of fibrosis in the myocardial tissue of rats in each dose group of ALF were improved or relieved， while the quantitative indicators of rats in the ALF-H group were significantly improved and significantly better than those in ALF-L group （P＜0.05）. K6PC-5 could significantly reverse the improvement effect of high-dose ALF on the above quantitative indicators in rats （P＜0.05）. CONCLUSIONS ALF can reduce myocardial fibrosis and improve cardiac function in AMI rats， and the effect may be related to the inhibition of the SphK1/S1P signaling pathway.

Effect of Ticagrelor on Left Ventricular Function in Patients with Mildly Reduced Ejection Fraction after Acute Myocardial Infarction

Abstract Background There are limited data about the effect of new P2Y12 inhibitors on left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI). Objectives We aimed to investigate the effect of ticagrelor on left ventricular function, compared to clopidogrel in patients with heart failure with mildly reduced ejection fraction (HFmrEF) after AMI. Methods In this cross-sectional, single-center study, we included 251 patients with LVEF between 40% and 50% after AMI before discharge. The patients were divided into 2 groups according to the use of ticagrelor (166 patients) and clopidogrel (85 patients). At the end of the 12-month period, LVEF changes were assessed by echocardiography. P < 0.05 was considered statistically significant. Results The mean LVEF before discharge was 46.5% ± 3.6%, and no difference was observed between the ticagrelor and clopidogrel groups (p = 0.20). At the end of the first year, the mean LVEF of the patients increased to 49.8% ± 7.6% in both groups. The use of ticagrelor (β ± SE = 2.05 ± 0.93; p = 0.029), low creatinine level (β ± SE = −10.44 ± 2.35; p < 0.001), low troponin level (β ± SE = −0.38 ± 0.14; p = 0.006), and low heart rate (β ± SE = −0.98 ± 0.33; p = 0.003) were found to be independent predictors of the increase in LVEF (β ± SE 2.05 ± 0.93; 95% confidence interval: 0.21 to 3.90; p = 0.029). Conclusion In our study, ticagrelor improved left ventricular function in 12 months follow-up compared to clopidogrel in patients with HFmrEF after AMI.

Validación de propuesta de escala predictiva de complicaciones cardiacas en el infarto agudo de miocardio

Introducción: La escala de riesgo diseñada para estimar la probabilidad de complicaciones cardiacas con enfoque clínico y ecocardiográfico, debe ser validada antes de su implementación en la práctica clínica. Objetivo: Validar una escala predictiva de complicaciones cardiacas en infarto agudo de miocardio con enfoque clínico-ecocardiográfico. Materiales y métodos: Se realizó un estudio analítico, observacional de casos y controles, de 1303 pacientes ingresados en el Centro de Cardiología y Cirugía Cardiovascular, de Santiago de Cuba, en el período 2019-2021, para lo cual fueron seleccionadas dos muestras: una de construcción del modelo (n = 800), y otra de validación de la escala, de enero a junio de 2022 (n = 198). Se determinaron los posibles predictores a través del análisis univariado y el cálculo de Odds ratio, con un nivel de significación de p ≤ 0,05. Asimismo, se elaboró un modelo de regresión logística binaria multivariada y se obtuvo la escala de riesgo, que fue validada por diferentes métodos. Resultados: La escala se obtuvo con 10 predictores y 2 estratos de riesgo. Esta alcanzó buena discriminación (80 %) y buen nivel de ajuste y validez de constructo (p = 0,70). Igualmente, aseguró una predicción correcta de más del 50 % de las complicaciones cardiacas, valores de sensibilidad y especificidad aceptables (92,03 % y 91,63 %, respectivamente), así como validez de contenido, validez interna y confiabilidad adecuadas. Conclusiones: La escala de riesgo para estratificar el riesgo de complicaciones cardiacas incluye predictores de gravedad de la enfermedad isquémica coronaria, con buenos parámetros de validación para ser usada en la toma de decisiones para prevenir.

Introduction: The risk scale designed to estimate the probability of cardiac complications with a clinical and echocardiographic approach must be validated before its implementation in clinical practice. Objective: To validate a predictive scale of cardiac complications in acute myocardial infarction with a clinical-echocardiographic approach. Materials and methods: An analytical, observational, case-control study was carried out on 1,303 patients admitted to the Cardiology and Cardiovascular Surgery center of Santiago de Cuba in the period 2019-2021, for which two samples were selected: one for model construction (n=800) and one for scale validation (n=198), from January to June 2022. Possible predictors were determined through univariate analysis and calculation of the odds ratio, with a significance level of p≤0.05; likewise, a multivariate binary logistic regression model was developed and the risk scale was obtained, which was validated by different methods. Results: The scale was obtained with 10 predictors and 2 risk strata. It achieved good discrimination (80%), and a good level of fit and construct validity (p=0.70). Likewise, it ensured a correct prediction of more than 50% of cardiac complications, acceptable sensitivity and specificity values (92.03% and 91.63%, respectively), as well as adequate content validity, internal validity and reliability. Conclusions: The risk scale to stratify the risk of cardiac complications includes predictors of severity of coronary ischemic disease, with good validation parameters to be used in decision-making to prevent.

Valoración del índice leucoglucémico como predictor de complicaciones del infarto agudo de miocárdico con ST elevado

Introducción: Se realizó una investigación descriptiva y prospectiva con la intención de definir el valor pronóstico del índice leucoglucémico en pacientes portadores de síndrome coronario agudo con elevación del ST. Objetivo: Valorar la importancia de la utilización del índice leucoglucémico como factor predictivo de complicaciones en el infarto agudo de miocardio con ST elevado. Métodos: Se estudió una muestra de 60 pacientes ingresados en la Unidad de Cuidados Intensivos del Hospital Clínico Quirúrgico Docente Amalia Simoni, de Camagüey, durante el año 2021, a los que se les llenó un cuestionario, de donde se obtuvieron: edad, color de la piel, antecedentes patológicos personales, hábitos tóxicos, complicaciones ocurridas, estado al alta y resultados del índice leucoglucémico. Los datos extraídos fueron manejados según estadística descriptiva, para obtener resultados en número y porciento, que conllevaron a las conclusiones finales. Resultados: Predominaron mujeres blancas mayores de 56 años de edad, hipertensas y diabéticas, asociadas al hábito de fumar en un gran porciento, con la aparición de múltiples complicaciones. También predominaron el cuadro de insuficiencia cardiaca y las arritmias en más de dos tercios de los casos, y hubo un número alto de fallecidos con índice leucoglucémico elevado. Conclusiones: Los resultados derivados de esta investigación apoyan el fundamento teórico-práctico de la utilización del índice leucoglucémico como predictor de complicaciones a corto plazo en el infarto agudo de miocardio con ST elevado, apreciado por su sencillez, amplia disponibilidad y bajo costo.

Introduction: A descriptive and prospective research was carried out with the intention of defining the prognostic value of the leuko-glycemic index in patients carrying acute coronary syndrome with ST elevation. Objective: To assess the importance of the use of the leuko-glycemic index as a predictive factor of complications in acute myocardial infarction with elevated ST. Methods: A sample of 60 patient was studied; they entered the Intensive Care Unit of the Clinical Surgical Teaching Hospital Amalia Simoni, of Camaguey, during 2021, and filled out a questionnaire from which age, color of skin, personal pathological antecedents, toxic habits, complications, status at discharge and results of the leuko-glycemic index were obtained. The extracted data were managed according to descriptive statistic to obtain results in number and percentage, which led to the final conclusions. Results: White women over 56 years old, hypertensive and diabetic predominated, associated with smoking in a large percent, and with the appearance of multiple complications. Heart failure and arrhythmias also predominated in more than two thirds of the cases, and there were a high number of deaths with high leuko-glycemic index. Conclusions: The results derived from this research support the theoretical-practical foundation of the use of the leuko-glycemic index as a predictor of short term complications in acute myocardial infarction with elevated ST, appreciated for its simplicity, wide availability and low cost.

Establishment and Evaluation of Animal Model of Acute Myocardial Infarction with Syndrome of Qi and Yin Deficiency / 中国实验方剂学杂志

ObjectiveTo explore the establishment and evaluation methods of the rat model of acute myocardial infarction （AMI） in coronary heart disease with the syndrome of Qi and Yin deficiency by sleep deprivation （SD） combined with isoproterenol （ISO） and preliminarily explore its biological basis. MethodForty SD rats were assigned into normal （no treatment）， SD （treatment in modified multi-platform water environment for 96 h）， ISO （subcutaneous injection of ISO at 100 mg·kg-1 once every other day for a total of 2 times）， and SD+ISO （injection of 100 mg·kg-1 ISO after SD for 72 h and 96 h） groups. The cardiac function was detected by small animal echocardiography. The serum levels of creatine kinase （CK）， creatine kinase isoenzyme （CK-MB）， lactate dehydrogenase （LDH）， and cardiac troponin T （cTnT） were measured by biochemical methods. The pathological changes of the myocardial tissue were observed by hematoxylin-eosin staining. The general state， body weight， grip strength， body temperature， behaviors in open field test， serum levels of cyclic adenosine monophosphate （cAMP）， cyclic guanosine monophosphate （cGMP）， cAMP/cGMP ratio， red （R）， green （G）， blue （B） values of the tongue surface， and pulse amplitude were observed and measured to evaluate the modeling results. Enzyme-linked immunosorbent assay was employed to determine the serum levels of interleukin-18 （IL-18）， tumor necrosis factor-α （TNF-α）， superoxide dismutase （SOD）， malondialdehyde （MDA）， corticotropin-releasing factor （CRF）， adrenocorticotropic hormone （ACTH）， triiodothyronine （T3）， tetraiodothyronine （T4）， cluster of differentiation 4 （CD4）， and cluster of differentiation 8 （CD8）. ResultIn terms of disease indicators， the ISO and SD+ISO groups had lower cardiac function indicators than the normal group （P<0.01）. The levels of CK， CM-MB， LDH and cTnT elevated in each model group compared with the normal group （P<0.01）. The pathological changes of myocardial tissue were obvious in the ISO and SD+ISO groups. In terms of syndrome indicators， compared with the normal group， the SD and SD+ISO groups showed decreased body weight at each time point （P<0.01）， and the ISO group showed decreased body weight at the time points of 48 h and 72 h （P<0.05， P<0.01）. The paw temperature and rectal temperature increased in the SD group （P<0.01）. The model groups showed weakened grasp strength， lowered R， G， and B values of the tongue surface （P<0.01）， prolonged immobility time （P<0.01）， reduced total distance and number of entering the central area （P<0.01）， decreased average speed （P<0.05， P<0.01）， and increased cAMP and cGMP （P<0.05， P<0.01）. The cAMP/cGMP ratio was increased in the SD+ISO group （P<0.01）， and the pulse amplitude was decreased in the SD and SD+ISO groups （P<0.01）. In terms of serological indicators，compared with the normal group， the levels of IL-18， TNF-α， SOD and MDA were significantly increased in the ISO and SD+ISO groups （P<0.01）， the CRF， ACTH， CORT， T3， T4， CD4 and CD8 in the model groups were increased （P<0.05， P<0.01）. ConclusionSleep deprivation for 96 h combined with high-dose ISO can successfully establish a rat model of acute myocardial infarction in coronary heart disease with the syndrome of Qi and Yin deficiency. The model evaluation system can be built with disease indicators of western medicine， histopathological indicators， macroscopic indicators of traditional Chinese medicine， and serological indicators.

The correlation between the expressions of serum Ang-2 and I-FABP and the prognosis of acute myocardial infarction with cardiac shock / 中国现代医生

Objective To investigate the correlation between angiopoietin-2(Ang-2)and intestinal fatty acid binding protein(I-FABP)levels and the prognosis of acute myocardial infarction(AMI)with cardiac shock(CS).Methods A total of 198 patients with AMI admitted to Huzhou Central Hospital from July 2017 to July 2019 were selected as study objects,and were divided into CS group(n=93)and non-CS group(n=105)according to whether CS occurred during the hospital period,and 65 normal volunteers admitted for physical examination during the same period were included in control group.Patients in CS group were divided into survival group(n=50)and death group(n=43)according to their survival at 28 days.Serum Ang-2 and I-FABP levels of all subjects were detected,and Cox regression analysis was used to analyze the factors affecting the poor prognosis of AMI with CS.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of Ang-2 and I-FABP in AMI with CS.Results Serum Ang-2 and I-FABP levels in CS group were significantly higher than those in non-CS group and control group(P<0.05),and serum Ang-2 and I-FABP levels in non-CS group were significantly higher than those in control group(P<0.05).Serum Ang-2,I-FABP levels and proportion of diabetes in death group were significantly higher than those in survival group(P<0.05).Cox regression analysis showed that diabetes,Ang-2 and I-FABP levels were independent factors affecting the prognosis of AMI with CS(P<0.05).ROC curve showed that the area under the curve of Ang-2 and I-FABP combined to predict the prognosis of AMI with CS was 0.819,sensitivity was 81.4%,specificity was 80.0%.Conclusion Serum Ang-2 and I-FABP levels were elevated in patients with AMI with CS,which were potential biological indicators to predict the prognosis of patients.

Clinical characteristics and nursing strategies of elderly patients with type 2 diabetes mellitus complicated with acute myocardial infarction / 中国现代医生

Objective To analyze the clinical characteristics and nursing strategies of elderly patients with type 2 diabetes mellitus complicated with acute myocardial infarction(AMI).Methods A total of 138 elderly patients with type 2 diabetes mellitus combined with AMI admitted to Jiangsu Province Hospital from January 2019 to December 2021 were included in observation group,and 346 patients with AMI without diabetes mellitus were enrolled in control group.The clinical data,complications,coronary angiography results and prognosis of two groups were collected and analyzed.Results The proportion of smoking,hypertension and typical chest pain in observation group were significantly lower than those in control group,while the proportion of hyperlipidemia and Killip grade≥Ⅲ were significantly higher than those in control group(P<0.05).The proportion of patients with three branch lesions or left main trunk lesions in observation group were significantly higher than those in control group(P<0.05).The incidences of arrhythmia,acute heart failure and pulmonary infection in observation group were significantly higher than those in control group(P<0.05).There was no significant difference in the incidence of cardiogenic shock and cardiac death during hospitalization between two groups(P>0.05).Conclusion Elderly patients with type 2 diabetes mellitus complicated with AMI have atypical clinical symptoms and more complications.Early identification and active control of cardiovascular risk factors by medical staff can reduce the mortality of patients and improve the long-term prognosis.

Index of microcirculatory resistance is associated with left ventricular remodeling in patients with acute anterior ST-segment elevation myocardial infarction undergoing emergency primary percutaneous coronary intervention / 北京大学学报(医学版)

Objective:To evaluate whether index of microcirculatory resistance(IMR)is associated with left ventricular(LV)remodeling in acute anterior ST elevation myocardial infarction(STEMI)pa-tients undergoing primary percutaneous coronary intervention(PPCI).Methods:This was a single-center retrospective cohort study.The patients with first anterior STEMI who received PPCI from January 2014 to August 2017 in Peking University Third Hospital was enrolled.After PPCI,IMR was measured immediately by using pressure/temperature guidewire.The success rate of IMR measurement was 100％.Also we collected some related clinical data from the medical records and laboratory results.Infarct size[assessed as creatine kinase(CK)peak],echocardiography at baseline and 1 year follow-up were as-sessed.LV adverse remodeling(LVAR)was defined as ≥20％increase in LV end-diastolic volume(LVEDV).Results:A total of forty-three patients were enrolled,with an average age of(58.7±12.4)years.The patients were divided into two groups as IMR ≤25 and IMR＞25 by normal values recommen-ded by previous literature.Compared with IMR ≤25 group,IMR＞25 group had a higher percentage of initial thrombolysis in myocardial infraction(TIMI)grade 0(95.7％vs.65.0％,P=0.029),higher serum CK peak value[4 090(383,15 833)vs.1 580(396,5 583),P=0.004].The IMR＞25 group suffered higher rates of ventricular aneurysm(30.4％vs.5.0％,P=0.021).There was no difference in LVEDV[(111.0±18.8)mL vs.(115.0±23.6)mL,P=0.503]between the two groups 1 day after MI,but after 1 year,LVEDV in IMR＞25 group was significantly higher than in IMR≤25 group[(141.5± 33.7)mLvs.(115.9±27.9)mL,P=0.018].The incidence of LVAR was more significant in IMR＞25 group(47.4％vs.11.8％,P=0.024).Binary Logistics regression showed that IMR[B=0.079,exp(B)(95％CI)=1.082(1.018-1.149),P=0.011]and serum triglyceride level[B=1.610,exp(B)(95％CI)=5.005(1.380-18.152),P=0.014]were the predictors of LVAR 1 year after MI.IMR had a good predictive value for LVAR 1 year after MI[area under the curve(AUC)=0.749,P=0.019],IMR＞29 was a good cutoff value with sensitivity 81.8％and specificity 68.0％.Conclusion:Our study elaborates that immediate measurement of IMR after PPCI in patients with STEMI can reflect the microvas-cular function.And IMR could be used as a quantitative biomarker to predict LVAR after STEMI.

Clinical application value of thromboelastogram combined with GRACE score in acute myocardial infarction / 国际检验医学杂志

Objective To analyze the correlation between thromboelastogram indicators(R time,K time,MA value)and global registry of acute coronary events(GRACE)score and acute myocardial infarction(AMI),and explore the risk factors for the onset of AMI.Methods A total of 108 patients with AMI who were hospitalized in Xuancheng Central Hospital for the first time from September 2020 to February 2023 were selected as the observation group,while 70 patients with stable coronary heart disease were selected as the control group.The clinical basic data,thromboelastogram indicators,GRACE score,and homocysteine(Hcy)of all study subjects were collected.The differences of clinical basic data,thromboelastogram indica-tors,GEACE score,and Hcy level between the observation group and the control group were statistically ana-lyzed.The predictive value of thromboelastogram indicators,GRACE score,and Hcy level for the occurrence of AMI was evaluated by using the receiver operating characteristic(ROC)curve.Binary Logistic regression model was used to conduct univariate and multivariate regression analyses on indicators with statistically sig-nificant differences,in order to determine the independent risk factors for AMI occurrence.Results There were significant differences of R time,K time,MA value,GRACE score,serum Hcy level,and the proportion of underlying diseases between the observation group and the control group(P＜0.05).The ROC curve re-sults showed that R time,K time,MA value,GRACE score,and Hcy had good predictive value for the occur-rence of different types of AMI,and the value of the combined application was higher.Univariate Logistic re-gression showed that MA value,GRACE score,Hcy level,and underlying disease were positively correlated with the occurrence of AMI(P＜0.05),while R time and K time were negatively correlated with the occur-rence of AMI(P＜0.05).Multivariate Logistic regression showed that high GRACE score and elevated Hcy level were independent risk factors for the occurrence of AMI(P＜0.05),while R time and K time were inde-pendent protective factors for the occurrence of AMI(P＜0.05).Conclusion Thromboelastogram,Hcy,and GRACE score could be used as dynamic monitoring indicators for clinical risk assessment of AMI in acute cor-onary syndrome population.

Analysis of in-hospital and long term prognosis of acute myocardial infarction patients with NT-proBNP peak value exceeding the upper limit / 国际检验医学杂志

Objective To analyze the in-hospital and long term prognosis of acute myocardial infarction(AMI)patients with N-terminal B-type brain natriuretic peptide(NT-proBNP)peak value exceeding the up-per limit.Methods A total of 669 patients with AMI diagnosed in a hospital from 2013 to 2018 were selected as research objects.According to the peak value level of NT-proBNP,they were divided into the NT-proBNP peak value exceeding the upper limit group(50 cases)and the NT-proBNP peak value detectable group(619 cases).Propensity score was used for matching(1:2),and the patients were divided into NT-proBNP peak value exceeding the upper limit group(50 cases)and NT-proBNP peak value detectable group(107 cases),and the in-hospital prognosis and long-term prognosis of the two groups were compared,as well as the echo-cardiographic indexes of each group in the acute stage and recovery stage of AMI.Multiple linear regression a-nalysis was used to predict the factors affecting left ventricular ejection fraction in the recovery stage of AMI.Results After matching the propensity score,compared with the NT-proBNP peak value detectable group,the neutrophil to lymphocyte ratio,hypersensitive C reactive protein level and fibrinogen level in the NT-proBNP peak value exceeding the upper limit group were higher at admission,and the differences were statistically sig-nificant(P＜0.05).The proportion of Killip≥ Grade Ⅱ,left ventricular ejection fraction,hospitalization time and major adverse cardiovascular and cerebrovascular events in the NT-proBNP peak value exceeding the up-per limit group were compared with those in the NT-proBNP peak value detectable group,and the differences were statistically significant(P＜0.05).The left ventricular ejection fraction and left ventricular shortening fraction of the NT-proBNP peak value detection group in AMI acute stage were higher than those in the NT-proBNP peak value exceeding the upper limit group in AMI acute stage,and the difference was statistically significant(P＜0.05).Multiple linear regression analysis showed the relationship between the NT-proBNP peak value during hospitalization and the left ventricular ejection fraction of cardiac function during AMI re-covery.The results suggested that the NT-proBNP peak value was not a risk factor affecting the left ventricu-lar ejection fraction of cardiac function during AMI recovery.Conclusion AMI patients with NT-proBNP peak value exceeding the upper limit should be treated with a series of comprehensive treatment strategies to pro-mote their rehabilitation and improve their long-term prognosis.

Efficacy of NT-proBNP,hs-CRP,D-D,and PCT in predicting heart failure after acute myocardial infarction based on ROC and DCA curve analysis / 国际检验医学杂志

Objective To investigate the predictive efficacy of serum aminoterminal brain natriuretic pep-tide precursor(NT-proBNP),hypersensitive C-reactive protein(hs-CRP),D-dimer(D-D)and procalcitonin(PCT)in heart failure after acute myocardial infarction(AMI),Methods A total of 100 AMI patients admit-ted to the hospital from July 2021 to July 2023 were enrolled in the study as the observation group,In addi-tion,100 healthy people who underwent physical examination in the hospital during the same period were en-rolled as the control group,The serum levels of NT-proBNP,hs-CRP,D-D and PCT were detected and com-pared between the observation group and the control group,The AMI patients enrolled in the study were fur-ther divided into the heart failure group(31 cases)and the non-heart failure group(69 cases)according to the presence or absence of heart failure.The serum levels of NT-proBNP,hs-CRP,D-D,and PCT were compared between the two groups,Univariate analysis and multivariate Logistic regression analysis were used to analyze the risk factors of heart failure after AMI,Receiver operating characteristic(ROC)curve and decision curve a-nalysis(DCA)were used to analyze the predictive efficacy of serum NT-proBNP,hs-CRP,D-D and PCT for heart failure after AMI.Results The levels of serum NT-proBNP,hs-CRP,D-D and PCT in the observation group were higher than those in the control group(P＜0.05).The serum levels of NT-proBNP,hs-CRP,D-D and PCT in the complicated heart failure group were higher than those in the non-heart failure group(P＜0.05),Body mass index(BMI),smoking history,hypertension,number of diseased vessels,serum uric acid(SUA),low-density lipoprotein cholesterol(LDL-C),NT-proBNP,hs-CRP,D-D and PCT were risk factors for heart failure after AMI(P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of combined detection of serum NT-proBNP,hs-CRP,D-D and PCT for predicting heart failure after AMI was 0.857(95％CI:0.811-0.948),the sensitivity was 96.12％,and the specificity was 91.28％,which were higher than the corresponding efficacy indexes of single detection(P＜0.05).DCA analysis showed that when the high-risk threshold was 0-0.99,the net benefit rate was greater than 0,which had clinical significance,When the threshold was 0-0.76,the net benefit rate of combined detection of serum NT-proBNP,hs-CRP,D-D and PCT was better than that of serum NT-proBNP,hs-CRP,D-D and PCT alone.Conclusion Combined detection of serum NT-proBNP,hs-CRP,D-D and PCT can improve the predictive efficiency of AMI compli-cated with heart failure,BMI,smoking history,hypertension,number of diseased vessels,SUA,LDL-C,NT-proBNP,hs-CRP,D-D and PCT are risk factors for AMI complicated with heart failure.

Influence of Qishen Yiqi Guttate Pills on the Clinical Efficacy of Patients with Acute Myocardial Infarction After Percutaneous Coronary Intervention / 广州中医药大学学报

Objective To observe the influence of Qishen Yiqi Guttate Pills(mainly composed of Astragali Radix,Salviae Miltiorrhizae Radix et Rhizoma,Notoginseng Radix et Rhizoma,and Dalbergiae Odoriferae Lignum)on the clinical efficacy of patients with acute myocardial infarction after percutaneous coronary intervention(PCI).Methods Sixty post-PCI patients with acute myocardial infarction of qi deficiency and blood stasis type who met the inclusion criteria were randomly divided into a treatment group and a control group,with 30 patients in each group.The control group was treated with conventional western medicine,and the treatment group was treated with Qishen Yiqi Guttate Pills on the basis of treatment for the control group.The course of treatment for the two groups lasted for 3 months.The changes of cardiac function indicators and serum levels of hypersensitive C-reactive protein(hs-CRP)and N-terminal B-type natriuretic peptide precursor(NT-pro BNP)were observed before and after the treatment in the two groups,and the incidence of cardiovascular adverse events during the treatment in the two groups were also compared.Results(1)After treatment,the serum hs-CRP and NT-pro BNP levels of patients in the two groups were significantly decreased(P＜0.05)and the left ventricular ejection fraction(LVEF)was significantly increased(P＜0.05)compared with those before treatment.And the effects on lowering the levels of serum hs-CRP and NT-pro BNP and on increasing LVEF of the treatment group were significantly superior to those of the control group,the differences being statistically significant(P＜0.05).(2)During the treatment period,the incidence of cardiovascular adverse events in the treatment group was 6.67%(2/30),which was significantly lower than 26.67%(8/30)of the control group,and the difference was statistically significant when comparing the two groups(P＜0.05).Conclusion Qishen Yiqi Guttate Pills can effectively improve cardiac function,decrease serum hs-CRP and NT-pro BNP levels,and reduce the occurrence of adverse cardiovascular events in post-PCI patients with acute myocardial infarction of qi deficiency and blood stasis type.

Research progress of high-sensitivity troponin in chronic kidney disease with acute myocardial infarction / 解放军医学杂志

The progress and clinical application of troponin detection technology have continuously improved the diagnosis rate of acute myocardial infarction(AMI),which effectively shortens the time of necrotic myocardial reperfusion.Earlier studies have found that high-sensitivity troponin(hs-cTn)is elevated to varying degrees in patients with chronic kidney disease(CKD).Therefore,when patients with CKD have AMI,the application of hs-cTn is limited to a certain extent,and with the lack of chest pain symptoms and the non-specificity of electrocardiogram performance in patients with CKD,it is particularly difficult to make a quick and accurate diagnosis of such patients.Based on this,this article will summarize the application of hs-cTn in AMI,the clinical characteristics of patients with CKD combined with AMI,how to improve the diagnostic accuracy of patients with CKD combined with AMI,and the value of hs-cTn in risk stratification and prognosis assessment of such patients to provide clinical medical staff with reference for early intervention or revascularization of patients.

The major adverse kidney events in acute myocardial infarction with extracorporeal cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To investigate the major adverse kidney events (MAKE) in acute myocardial infarction (AMI) with extracorporeal cardiopulmonary resuscitation (ECPR).Methods:The data of 75 patients with AMI-ECPR in Emergency Medicine Department of the First Affiliated Hospital of Nanjing Medical University from April 2015 to April 2023 were retrospectively analyzed. The patients were grouped by survival/death at 90 days, with/without renal replacement therapy (RRT), and whether to initiate RRT because of acute kidney injury (AKI). age, sex, Charlson comorbidity index, OHCA/IHCA (out-of-hospital/in-hospital cardiac arrest), initial rhythm, Gensini score, ECPR initial blood gas pH and lactate value, no-flow time, time from cardiac arrest to extracorporeal membrane oxygenation (ECMO) initiation (CA-Pump On time), ECMO and RRT treatment time, 90-day survival rate were analyzed. Moreover, the renal function of the survivors was followed up.Results:① Total of 68 AMI-ECPR patients were enrolled, 22 (32.4%) patients survived at 90 days, 54 (79.4%) combined with RRT, and 48 (70.6%) MAKE within 90 days. ②Compared with the death group, the 90-day survival group had a higher proportion of initial shockable heart rhythm, a lower Gensini score, a higher ECPR initial blood gas pH and a lower lactic acid value. ③The severity of coronary artery disease, ECPR initial acidosis and hyperlactacemia in the RRT group was significantly higher than that in the non-RRT group, and all the non-RRT group patients survived. ④ There was no difference between the AKI-RRT group and the non-AKI-RRT group. Of 21 patients with stage 1 AKI initiating RRT, 5 survived, one of them still needs RRT for 90 days, and 7 patients with stage 2 to 3 AKI initiating RRT died.Conclusions:The 90-day MAKE rate in AMI-ECPR patients was as high as 70.6%, and the 90-day renal insufficiency rate in AMI-ECPR survivors with AKI was as high as 20.0%. Active initiation of RRT to avoid AKI or early initiation of RRT may improve the prognosis of AMI-ECPR patients.

Changes and significance of complement C1q/tumor necrosis factor-related protein-12 in serum of patients with acute myo-cardial infarction before and after percutaneous coronary intervention / 临床检验杂志

Objective To investigate the changes of C1q tumor necrosis factor-related protein-12(CTRP12)levels in serum of the pa-tients with acute myocardial infarction(AMI)before and after percutaneous coronary intervention(PCI),and explore its clinical sig-nificance.Methods A total of 50 patients with AMI who underwent emergency PCI and 35 patients with normal coronary angiography results in Danyang People's Hospital from November 2021 to October 2022 were enrolled.The CTRP12 levels in peripheral venous ser-um were compared between the two groups.The levels of serum CTRP12 levels were measured before,during and on the 3rd,5th and 7th day after PCI.The serum CTRP12 levels in culprit coronary ostium and peripheral vein were compared.CTRP12 levels in peripher-al venous serum were compared at different time points after PCI.The severity of coronary artery disease was evaluated by SYNTAX score system,and the AMI patients were divided into two groups:SYNTAX score ≤22 and SYNTAX score＞22.The serum CTRP12 levels were compared between the two groups and before and after PCI.The correlation between CTRP12 and age,body mass index(BMI),fasting blood glucose,blood lipid and other factors was analyzed.The influencing factors of the severity of coronary artery le-sions were analyzed by logistic regression.Results The serum CTRP12 level in the patients with AMI was significantly lower than that in healthy controls(P＜0.05).There was no significant difference between the serum CTRP12 levels between preoperative peripheral vein and intraoperative culprit coronary orifice(P＞0.05).Compared with that before PCI,the serum CTRP12 level was lower on the 3rd day after PCI(P＜0.05),and increased on the 5th and 7th days after PCI,but no statistically significant difference was found(P＞0.05).Compared with those on the 3rd day after PCI,the serum CTRP12 levels were increased on the 5th and 7th day after PCI,but no statistically significant differences were found(all P＞0.05).Compared with that in the SYNTAX≤22 group,the CTRP12 levels were significantly lower than those before PCI and on the 3rd day after PCI(all P＜0.05),while there was no significant difference on the 5th and 7th day after PCI in SYNTAX＞22 group(all P＞0.05).CTRP12 was negatively correlated with the level of total cholesterol(TC)and positively correlated with high-density lipoprotein cholesterol(HDL-C).Univariate logistic regression analysis showed that CTRP12 was an independent influencing factor for the severity of coronary artery disease in the patients with AMI(β=-1.671,OR=0.188,P＜0.05).After adjusting for the effects of age,gender,BMI,smoking,hypertension,diabetes,fasting blood glucose,total cholesterol(TC),triglyceride(TG),HDL-C and low-density lipoprotein cholesterol(LDL-C),CTRP12 was still an independent in-fluencing factor for the severity of coronary artery disease in the patients with AMI(β=-3.441,OR=0.032,P＜0.05).Conclusion The serum CTRP12 level was significantly decreased in the patients with AMI before PCI,and showed continuous decline on the 3rd day after PCI,but increased on the 5th and 7th day after PCI.CTRP12 should be an independent influencing factor for the severity of coronary artery disease in the patients with AMI.

Research on risk factors for microcirculation obstruction after acute myocardial infarction reperfusion / 实用放射学杂志

Objective To investigate the risk factors of microcirculation obstruction(MVO)after reperfusion in patients with acute myocardial infarction(AMI).Methods Forty-one patients with AMI who received treatment with myocardial reperfusion were retrospectively selected.Cardiac magnetic resonance(CMR)was used to determine whether the patients had MVO.The patients were divided into MVO and non-MVO groups.The basic data,laboratory examination and CMR parameters of patients were collected and compared between the groups,and the risk factors related to MVO were screened out by logistic regression analysis.Results Delayed myocardial enhancement was observed in all 41 patients,among which 11 cases(26.8%)were with MVO.A total of 206 delayed myocardial enhancement segments were observed,of which 77 segments combined with MVO and 129 segments without MVO.AMI patients with MVO had a higher rate of transmural myocardial infarction,greater infarct volume,left ventricular myocardial mass(LVMM)and edema degree,as well as lower ejection fraction of left and right ventricles(P<0.05).Multivariate logistic regression analysis indicated that infarct volume[odds ratio(OR)=1.116,95%confidence interval(CI)1.017-1.224,P=0.020]was an independent risk factor for MVO after AMI reperfusion.Conclusion Infarct volume is an independent risk factor for MVO after AMI reperfusion,and MVO is associated with left and right ventricular function impairment.

Efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction compli-cated with heart failure / 实用医学杂志

Objective To observe the efficacy of ivabradine combined with levosimendan in patients with acute myocardial infarction complicated with heart failure.Methods A total of 78 patients with acute myocardial infarction complicated with heart failure admitted to the hospital from May 1,2020 to December 31,2022 were selected and divided into control group(n = 39)and study group(n = 39)by random number table method.In addition to basic treatment,the control group received levosimendan,and the study group ivabradine and levosi-mendan.The treatment period of both groups was 4 weeks.Compare two groups of patients'vital signs,clinical curative effect and heart function index,serological indexes,inflammatory factors and security.Results Compared with before treatment,the systolic blood pressure,diastolic blood pressure and heart rate of the two groups were decreased after treatment(P<0.05),and the systolic blood pressure,heart rate,diastolic blood pressure and heart rate of the study group were significantly decreased compared with the control group(P<0.05).Compared with the control group,the total effective rate of the study group was significantly higher(P<0.05).Compared with before treatment,the levels of CO and LVEF were increased(P<0.05),while the levels of LVEDV and LVESV were decreased(P<0.05).Compared with the control group,the levels of CO and LVEF in the study group were higher(P<0.05),and the levels of LVEDV and LVESV in the study group were lower(P<0.05).Compared with before treatment,the levels of cTnI,sST2 and NT-proBNP in both groups were decreased after treatment(P<0.05),and the serum levels of cTnI,sST2 and NT-proBNP in the study group were significantly decreased compared with the control group(P<0.05).Tumor necrosis factor α(TNF-α),myeloperoxidase(MPO)and highly sensitive C-reactive protein(hs-CRP)were all decreased after treatment in the two groups(P<0.05),and those in the study group were much lower(P<0.05)No difference between the incidence of adverse reactions to the total contrast the two groups(P>0.05).Conclusion Levosimendan combined with ivabadinehave a definite effect on patients with acute myocardial infarction complicated with heart failure for the improved cardiac function,reduced inflammation,regulated serum sST2,cTnI,and NT-proBNP level.It is also safe and reliable

The advanced progress on the relationship between hyperuricemia and acute myocardial infarction / 实用医学杂志

Acute myocardial infarction(AMI)is one of the leading causes of cardiac death.The percutane-ous coronary intervention(PCI)can improve the prognosis of AMI patients,but the overall prognosis of AMI patients is not optimistic.Hyperuricemia has become one of the risk factors for cardiovascular diseases.The role of hyperuricemia in the occurrence,development and prognosis of AMI has attracted increasing attention.This article reviews the research progress on the relationship between hyperuricemia and AMI.