Associations between postprocedural D-dimer, hs-CRP, LDL-C levels and prognosis of acute myocardial infarction patients treated by percutaneous coronary intervention / 中华心血管病杂志

Objective: To investigate the association between postprocedural D-dimer, high sensitivity C-reactive protein(hs-CRP) and low-density lipoprotein-cholesterol(LDL-C) and outcomes of acute myocardial infarction (AMI) patients treated by percutaneous coronary intervention(PCI), in order to clarify the impacts of thrombotic, inflammatory and cholesterol risks on long-term prognosis. Methods: Patients with AMI who underwent emergency PCI from January 2010 to June 2017 in Fuwai Hospital with complete baseline data were enrolled. Patients were stratified into four groups according to quartiles of D-dimer, hs-CRP and LCL-C. Cox regression was used to analyze the relationship between these biomarkers and prognosis. Restricted cubic spline (RCS) was used to characterize the continuous association between risk of all-cause death and biomarkers. The primary outcome was all-cause death. Results: A total of 3 614 patients were included in the analysis. The age was (59.2±12.0) years old, and 2 845 (78.7%) were male and 3 161 (87.5%) patients were diagnosed as ST-segment elevation myocardial infarction. The follow-up time was 652 (414, 1 880) days. Survival analysis showed that postprocedural D-dimer and hs-CRP were significantly associated with all-cause mortality (all P<0.05). Cox regression with multiple adjustments showed that patients with D-dimer≥580 μg/L presented higher risk of all-cause death (HR=2.03, 95%CI 1.22-3.38, P=0.006), compared to patients with D-dimer<220 μg/L. RCS analysis showed that risk of all-cause death was stably high when D-dimer reached 500 μg/L. Multivariable Cox regression also showed that patients with hs-CRP<2.74 mg/L (HR=1.86, 95%CI 1.10-3.15, P=0.020)or hs-CRP≥11.99 mg/L (HR=2.14, 95%CI 1.35-3.40, P=0.001) presented higher mortality compared to patients whose hs-CRP was 2.74-7.18 mg/L. RCS analysis indicated a J-shaped relation between hs-CRP and mortality, as greater risk of death was observed when hs-CRP was lower than 2 mg/L or higher than 10 mg/L. LDL-C was not associated with outcomes (all P>0.05). Conclusions: Postprocedural D-dimer is significantly associated with long-term prognosis of AMI patients treated by PCI. Patients with extremely high or low levels of hs-CRP presents worse outcomes. Intensive and tailored antithrombotic or anti-inflammatory therapies should be considered for patients with increased thrombotic risk and those with extremely high or low inflammatory risk.

Analysis for Risk Factors of Death in Atrial Fibrillation Patients With or Without Heart Failure / 中国循环杂志

Objective: To explore the risk factors of death in atrial fibrillation (AF) patients with or without heart failure (HF). Methods: A total of 2015 emergency AF patients from 20 hospitals in China from 2008-11 to 2011-10 were consecutively enrolled. Based on existing HF, the patients were divided into 2 groups: HF group, n=753 and Non-HF group, n=1263. The baseline condition and in-hospital treatment were recorded, patients were followed-up for 1 year to document all-cause death and the relevant risk factors were studied by multivariate Cox regression analysis. Results: Compared with Non-HF group, HF group had less male, lower heart rate (HR) and body mass index (BMI), less patients with previous histories of hypertension and hyperthyreosis, lower application rates of calcium antagonists and amiodarone, all P<0.05; HF group had the higher CHADS2score, more patients with previous histories of myocardial infarction, coronary artery disease, congenital heart disease (HD), valvular HD, rheumatic HD, left ventricular (LV) hypertrophy, smoking, LV dysfunction, cognitive disorder,pneumonectasis/chronic obstructive pulmonary disease (COPD), valvular surgery and major bleeding; higher application rates of diuretics, ACEI, digoxin, aspirin and warfarin, all P<0.05. 1991 patients finished follow-up study and during that period, compared with Non-HF group, HF group showed the lower usage rates of rhythm-control drugs and clopidogrel, while higher usage rates of ventricular-control drugs and warfarin, all P<0.05; higher incidences of death and major bleeding, all P<0.05. Cox regression analysis indicated that HF was the risk factor for 1 year mortality in AF patients (HR=1.50, 95% CI 1.17-1.92, P=0.001). In Non-HF group, age (HR=1.09, 95% CI 1.07-1.11, P<0.001), heart rate (HR=1.011, 95% CI 1.005-1.017, P<0.001), primary diagnosis (HR=1.63, 95% CI 1.13-2.35, P=0.01) and COPD (HR=2.18, 95% CI 1.47-3.22, P<0.001) were related to 1 year death. In HF group, age (HR=1.05, 95% CI 1.03-1.07, P<0.001), BMI (HR=0.92, 95% CI 0.88-0.96, P<0.001), systolic blood pressure (HR=0.991, 95% CI 0.984-0.998, P=0.012) and primary diagnosis (HR=2.50, 95% CI 1.48-4.21, P=0.001) were related to 1 year death. Conclusion: Baseline condition and in-hospital treatment were different in AF patients with or without HF. HF was the risk factor for 1 year mortality and the other risk factors were different in AF patients with or without HF.

Risk factors of short term mortality in patients with acute ST-elevation myocardial infarction complicated with fatal arrhythmia / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the independent risk factors associated with short term mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) complicated with fatal arrhythmia.</p><p><b>METHODS</b>We analyzed data from Chinese STEMI patients with fatal arrhythmia enrolled in the CREATE trial. Predictors of 30-day mortality after STEMI were identified by univariate and multivariate logistic regression analysis using baseline and therapy variables.</p><p><b>RESULTS</b>The overall 30-day mortality of STEMI patients complicated with fatal arrhythmia among the 718 patients [(66.1 ± 11.9) years and 62.4% male] was 52.9%. Logistic regression analysis showed that age (OR = 1.82, 95%CI:1.449-2.285), anterior infarction (OR = 4.419, 95%CI:2.645-7.384), heart rate > 60 bpm (OR = 3.32, 95%CI:1.898- 5.808), killip class IV (OR = 3.686, 95%CI:1.684-8.06), admission hemoglobin A1c < 5.6% (OR = 2.564, 95%CI:1.199-5.484), no use of ACEI (OR = 1.827, 95%CI:1.099-3.038) and no use of lipid-low drugs (OR = 2.034, 95%CI:1.196-3.458) were independent risk factors for short term mortality after STEMI. The receiver operating characteristic curve for predicting the death of the baseline and clinical variable models was 0.830 (95%CI: 0.796-0.865) and 0.866 (95%CI: 0.835-0.896), respectively.</p><p><b>CONCLUSION</b>The 30-day mortality of patients with STEMI complicated with fatal arrhythmia is high. Age, anterior infarction, heart rate > 60 bpm, killip class IV, admission hemoglobin A1c level < 5.6%, no use of ACEI and no use of lipid-low drugs are independent risk factors for 30-day mortality in these patients.</p>

The impact of hypertension history and baseline blood pressure levels on the cardiovascular outcomes in Chinese emergency atrial fibrillation patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the impact of hypertension history and baseline blood pressure levels on cardiovascular outcomes in Chinese emergency atrial fibrillation patients during 1 year follow-up.</p><p><b>METHODS</b>This prospective study consecutively enrolled patients presenting to an emergency department with atrial fibrillation from 20 hospitals in China during November 2008 to October 2011. Baseline data and treatment regimen were recorded, all patients were followed up for one year, and major cardiovascular events (MACE including cardiovascular death, stroke, myocardial infarction, and non central nervous systemic embolism) were recorded. Patients were divided into hypertension history group and non-hypertension history group. Univariate Cox analysis was evaluated hypertension history, baseline blood pressure on major cardiovascular events. Multivariate Cox analysis recognized risk factors for major cardiovascular events.</p><p><b>RESULTS</b>A total of 2016 atrial fibrillation patients were enrolled, and the average systolic blood pressure and diastolic blood pressure were (131.9 ± 23.3)mm Hg(1 mm Hg = 0.133kPa), (79.9 ± 14.7)mm Hg respectively. 1118 patients (55.5%) had a history of hypertension, and about 91.1% hypertension patient received antihypertensive treatment. Major cardiovascular events occurred in 314 cases (15.6%) among 1 year follow up, and 191 cases (17.1%) among hypertension group and 123 cases (13.7%) among non-hypertension group. Univariate Cox regression analysis of prognostic factors for major cardiovascular events showed that hypertension history and baseline systemic blood pressure were risk factors (HR = 1.269, 95%CI: 1.012-1.592, P = 0.039; HR = 1.005, 95%CI: 1.000-1.010, P = 0.042). Multivariate Cox regression model analysis, adjusted others risk factors, showed that hypertension history, baseline systolic pressure levels, and baseline diastolic blood pressure did not have independent predictive value for major cardiovascular events. Moreover, multivariate Cox regression analysis showed that age, history of heart failure, history of stroke were independent prognostic factor for one year follow-up of major cardiovascular events in atrial fibrillation patients.</p><p><b>CONCLUSION</b>Age, history of heart failure, history of stroke were independent predictor for 1 year major cardiovascular events in Chinese emergency atrial fibrillation patients.</p>

Clopidogrel metabolism related gene polymorphisms in Chinese patients with acute coronary syndrome / 中华心血管病杂志

<p><b>OBJECTIVE</b>To detect the single nucleotide polymorphisms of clopidogrel metabolism related genes (CYP2C19, ABCB1 and PON1) in Chinese patients with acute coronary syndrome (ACS) by genotype analysis.</p><p><b>METHODS</b>Genetic analysis was performed in patients admitted to Fuwai Hospital from 2005 to 2008 with ACS within 4 weeks. The detection of polymorphisms was performed by TaqMan real-time PCR method. The alleles genotyped were CYP2C19 *2-*8, *17, ABCB1 C3435T, PON1 Q192R and PON1 L55M. Minor allele frequency (MAF) was calculated. Patients were classified as one of the 5 categories by clopidogrel metabolizer phenotypes as extensive [without any "loss-of-function" (LOF) allele *2-*8 or "gain-of-function" (GOF) allele *17], intermediate (with only one LOF allele), Poor (with two or more LOF alleles), ultra (with one or two GOF alleles) or unknown (with one LOF allele and one GOF allele).</p><p><b>RESULTS</b>A total of 2800 ACS patients were enrolled [mean age (59.0 ± 12.3) years and 2236 males (79.9%)]. There were 74% patients with ST-segment elevation myocardial infarction (STEMI, n = 2072), 22.0% patients with non-ST-segment elevation myocardial infarction (NSTEMI, n = 617) and 4.0% patients with unstable angina (UA, n = 111). The minor allele frequency (MAF) for each genotype of CYP2C19 *2, *3, *4, *17 was 28.7%, 4.6%, 0.1% and 1.2%, respectively. There was no LOF allele *5-*8 in the study population. The MAF for ABCB1 C3435T, PON1 Q192R and PON1 L55M was 39.4%, 37.8% and 4.4%, respectively. Clopidogrel metabolizer groups were defined as extensive in 41.7%, intermediate in 45.6%, poor in 10.3%, ultra in 1.9% and unknown in 0.6% patients, respectively. There were no significant differences for all genotypes between males and females. Total LOF carriers of CYP2C19 were 56.4% and GOF carriers were 2.5%.</p><p><b>CONCLUSIONS</b>Our study demonstrated a high distribution of the LOF allele of CYP2C19 in China ACS population.</p>

Impact of admission heart rate on short-term outcome of ST-elevation myocardial infarction patients / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the impact of admission heart rate (HR) on 30-day all-cause death and cardiovascular events in Chinese patients with ST-elevation acute myocardial infarction (STEMI).</p><p><b>METHODS</b>A total of 7485 Chinese STEMI patients from a global randomized controlled trial (CREATE) database were divided into six groups by admission HR: < 60, 60 - 69, 70 - 79, 80 - 89, 90 - 99 and ≥ 100 bpm. The primary outcome was 30-day all-cause death; the secondary outcomes were the composite of 30-day all-cause death, reinfarction, cardiogenic shock or deadly arrhythmia.</p><p><b>RESULTS</b>Admission glucose level, proportion of female gender, incidence of anterior myocardial infarction, previous diabetes mellitus, hypertension and Killip level II-IV were significantly higher in patients with admission HR ≥ 90 bpm compared to 60 - 69 bpm group (P < 0.05). The 30-day mortality was lowest (6.3%) in the 60 - 69 bpm group and was 9.6% in HR < 60 bpm group (P < 0.05 vs. 60 - 69 bpm group). In patients with admission HR > 60 bpm, the 30-day mortality increased in proportion to higher admission HR: 8.1% in 70 - 79 bpm, 9.2% in 80 - 89 bpm, 12.6% in 90 - 99 bpm and 24.6% in ≥ 100 bpm groups (all P < 0.05 vs. 60 - 69 bpm group). The incidence of MACE was similar as that of 30-day mortality: 27.0% in < 60 bpm, 12.5% in 60 - 69 bpm, 13.7% in 70 - 79 bpm, 14.3% in 80 - 89 bpm, 17.5% in 90 - 99 bpm and 31.1% in ≥ 100 bpm groups. Multivariate analysis showed that the incidence of 30-day mortality positively correlated with the admission HR (P < 0.05) except in the patients with admission HR < 60 bpm (OR = 0.832, P = 0.299), the risk of joint endpoint events was higher in the patients with HR < 60 bpm (OR = 1.532, 95%CI: 1.201 - 1.954, P < 0.05), 90 - 99 bpm (OR = 1.436, 95%CI: 1.091 - 1.889, P < 0.05) or ≥ 100 bpm (OR = 1.893, 95%CI: 1.471 - 2.436, P < 0.001).</p><p><b>CONCLUSION</b>Admission HR is an independent risk factor for short-term outcome in Chinese STEMI patients.</p>

Comparison on therapeutic approach and short-term outcomes between male and female patients with ST-segment elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the differences on therapeutic approach and short-term outcomes between male and female patients with ST-elevation myocardial infarction (STEMI).</p><p><b>METHODS</b>Data of Chinese STEMI patients were retrospectively analyzed from a global multicenter clinical trial of reviparin and metabolic modulation in acute myocardial infarction treatment evaluation (CREATE). The patients were divided into two groups according to gender and difference on demographic, baseline clinical characteristics at admission, reperfusion and drug therapy and 30-day all-cause mortality, re-infarction, stroke, hemorrhage, heart failure and combined end points were compared.</p><p><b>RESULTS</b>Of the 7431 patients, 29.1% were female. Female patients were older than male patients [(68.2 ± 9.1) years vs. (60.3 ± 12.1) years]. On admission, heart rate, diastolic blood pressure and Killip class were higher and the delay between onset of chest pain and arrival at hospital was longer in female patients than in male patients (all P < 0.01). Male patients often presented MI in anterior leads while female patients often presented MI in inferior and lateral leads. History of diabetes mellitus, hypertension and heart failure was significantly higher in female than in male patients (all P < 0.01). Incidence of high blood glucose was higher in female while high blood potassium was higher in male patients (P < 0.01). Rate of reperfusion therapy was lower and the use aspirin and diuretic was more frequent in female patients than in male patients, while frequency of clopidogrel, Glycoprotein IIb/IIIa receptor inhibitor, β-blockers, angiotensin converting enzyme inhibitor, lipid-lowering drug use was significantly higher in male than in female patients (all P < 0.01). Multivariate logistic regression analysis showed that female gender was a predictor for less PCI therapy (P < 0.01). Thirty-day all cause mortality (OR = 1.425, 95%CI: 1.163 - 1.747, P < 0.01) and combined end points (OR = 1.193, 95%CI: 1.010 - 1.410, P = 0.04) were significantly higher in female patients than in male patients.</p><p><b>CONCLUSIONS</b>There are gender-related differences on therapeutic approach and short-term outcome in Chinese STEMI patients. The unfavorable demographic and baseline clinical profile could partially explain the less reperfusion therapy rate and worse prognosis in female patients.</p>

Clinical characteristics of 52 patients with torsade de points associated with acquired QT prolongation / 中华心血管病杂志

<p><b>OBJECTIVE</b>Risk factors, ECG characteristics and treatment options of patients with Torsade de Points associated with acquired QT prolongation are summarized in this study.</p><p><b>METHOD</b>Using "torsade de points" and "QT prolongation" as the keywords to search the inpatients database from 1990 - 2010 of Fuwai hospital, 52 eligible patients were included in this analysis.</p><p><b>RESULTS</b>Structural heart diseases were found in 67.3% and electrolyte disorders in 59.6% patients, 36.5% patients received diuretic therapy and 28.8% received antiarrhythmic drugs which might induce prolonged QT interval. The mean QTc was (571 ± 93) ms and (456 ± 50) ms before and after treatment. All patients received potassium and magnesium supplement. Isoproterenol was used in 32.7% patients. 13.5% patients received temporary pacing therapy.</p><p><b>CONCLUSIONS</b>Torsade de points and acquired QT interval prolongation was often associated with electrolyte disorders and drugs causing QT prolongation. ECG and QTc should be intensively monitored for high risk patients. Early awareness of the warning signs might contribute to early recognition and proper treatment of patients with Torsade de Points associated with acquired QT prolongation.</p>

Nifekalant hydrochloride terminating sustained ventricular tachycardia accompanied with QT dispersion prolongation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Ventricular tachycardia (VT) and ventricular fibrillation are the main reasons causing sudden cardiac death. This study aimed to investigate the effects of nifekalant hydrochloride (NIF) on QT dispersion (QTd) in treating VT.</p><p><b>METHODS</b>A total of 16 consecutive patients suffered sustained VT was included and then randomly divided into two groups according to the administration duration of NIF. In long-time group (group L), patients were injected with NIF continuously for at least 12 hours after a bolus dose. The patients in short-time group (group S) were injected with NIF just for 1 hour.</p><p><b>RESULTS</b>There were 7 of all 10 episodes of VT which were terminated by NIF, including 4 episodes in group L were stopped over 1 hour after continuous infusion of NIF. One patient suffered from torsade de pointes. Electrocardiography analysis indicated that QTd was significantly decreased 12 hours after stopping of infusing NIF compared with that when VT stopped ((45.4 +/- 22.1) ms vs. (73.4 +/- 33.2) ms, P < 0.01), and the corrected QTd (QTcd) decreased too ((47.8 +/- 22.9) ms vs. (78.3 +/- 36.5) ms, P < 0.01). There was a positive correlation between the increase in QTd and dose of administrating NIF (P < 0.01), so was QTcd (P < 0.01).</p><p><b>CONCLUSIONS</b>More administration of NIF indicates higher terminating rate of VT and more QTd prolongation. However, the safety is acceptable if several important issues were noticed in using NIF, such as serum potassium concentration, stopping side-effect related agents, and carefully observing clinical responses.</p>

Impact of first 24 hours mean blood glucose level on the prognosis of hospitalized patients with ST-segment elevation myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the impact of the first 24 hours mean blood glucose (MBG) level and admission glucose (AG) during hospitalization on the short term mortality and combined end point events in patients with ST-segment elevation acute myocardial infarction (STEMI).</p><p><b>METHODS</b>A total of 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset were included. Plasma glucose was measured at admission, 6 and 24 hours after admission, respectively. The MBG level through the first 24 hours for each patient was calculated. Patients were stratified into six groups according to their MBG levels: < 4.5, 4.5 - 5.5, 5.6 - 7.0, 7.1 - 8.5, 8.6 - 11.0 and > 11.0 mmol/L. The incidence of all-cause mortality and combined end point of death, re-infarction, cardiogenic shock, recurrence ischemia, and stroke at 7 days and 30 days post hospitalization were analyzed. Nested models were compared to determine whether logistic regression models that included MBG provided a significantly better fit than logistic regression models included AG.</p><p><b>RESULTS</b>Compared with the MBG of 4.5 - 5.5 mmol/L group, 7-day and 30-day mortality and combined end point events increased in proportion to plasma MBG level increase. Multivariate logistic regression analysis showed that elevated MBG (equal or greater than 7.1 - 8.5 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. Nested models analysis showed that the prognostic impact of MBG is superior to AG (P < 0.001) on predicting 7-day and 30-day mortality and combined end point events in this patient cohort.</p><p><b>CONCLUSION</b>Elevated MBG (≥ 7.1 mmol/L) level is an independent predictor of 7-day and 30-day mortality and combined end point events. MBG is superior to AG on predicting short-term prognosis in this patient cohort.</p>

Predictive value of admission amino-terminal pro-B-type natriuretic peptide on in-hospital mortality in patients with decompensated heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the predictive value of admission plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) on in-hospital mortality in patients with decompensated heart failure.</p><p><b>METHODS</b>Plasma NT-proBNP levels were measured in patients with decompensated heart failure within 24 hours after admission with ELISA method. The NT-proBNP levels were compared between survivals and dying patients in hospital. ROC analyses were performed to evaluate the predictive value of admission plasma NT-proBNP on in-hospital mortality and to identify the optimal NT-proBNP cut-point for predicting in-hospital mortality. A binary logistic regress analyses was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality.</p><p><b>RESULTS</b>A total of 804 patients with decompensated heart failure were enrolled in his study (293 valvular heart diseases, 219 ischemic cardiomyopathy, 141 dilated cardiomyopathy, 14 hypertrophic cardiomyopathy, 21 restrictive cardiomyopathy, 39 hypertensive heart disease, 41 chronic pulmonary heart disease and 36 adult congenital heart disease) and 96 patients were in class II, 450 in class III and 258 in cases IV according to NYHA Classification. During hospitalization, 64 deaths were recorded and the on admission plasma NT-proBNP levels of patients died during hospitalization were significantly higher than those of survivals [4321.1 (3063.8, 6606.5) pmol/L vs. 1921.6 (873.9, 3739.2) pmol/L, P<0.01]. Area under receiver operating characteristic curve (AUC) of NT-proBNP to predict in-hospital death was 0.772 (95% CI: 0.718 - 0.825, P<0.01), the optimal plasma NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L, with a sensitivity of 70.3%, a specificity of 72.0%, an accuracy of 71.9%, a positive predictive value of 17. 8% and a negative predictive value of 96.6%. Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had a much higher in-hospital mortality (17.8%) compared with those with NT-proBNP levels of less than 3500 pmol/L (3.4%), P<0.01. Binary logistic regress analyses demonstrated that admission plasma NT-proBNP, pneumonia, heart rate and NYHA class were independent predictors for in-hospital mortality in patients with decompensated heart failure (P<0.05 or 0.01) and admission plasma NT-proBNP was the strongest predictor for in-hospital mortality.</p><p><b>CONCLUSIONS</b>Admission plasma NT-proBNP level was an independent predictor for in-hospital mortality in patients with decompensated heart failure. The optimal NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L in this patient cohort.</p>

Impact of admission blood glucose on prognosis of ST-segment elevation myocardial infarction patients with or without known diabetes / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the impact of admission blood glucose level on 30-day mortality in ST-segment elevation acute myocardial infarction (STEMI) patients with or without known diabetes.</p><p><b>METHOD</b>This observational analysis enrolled 7446 Chinese STEMI patients hospitalized within 12 hours of symptom onset joining a global randomized controlled trial. The patients with or without known diabetes were divided into different groups by the admission blood glucose level: < 6.1 mmol/L (n = 2018), 6.1 to 7.7 mmol/L (n = 2170), 7.8 to 11.0 mmol/L (n = 1929), 11.1 to 13.0 mmol/L (n = 465), > 13.0 mmol/L (n = 864), the last three groups were defined as the hyperglycemia group. The 30-day mortality was analyzed.</p><p><b>RESULT</b>A substantial proportion of hyperglycemic patients did not have recognized diabetes. Insulin use during hospitalization in hyperglycemic patients without known diabetes was significantly lower than that in known diabetics with similar glucose levels. Incidence of 30-day mortality increased in proportion to increasing admission glucose levels in patients without known diabetes (glucose< 6.1 mmol/L 6.8%, 6.1 to 7.7 mmol/L 8.3%, glucose > 13.0 mmol/L 18.6%, P < 0.001). In patients with known diabetes, the 30-day mortality was 16.7% with admission glucose < 6.1 mmol/L and 8.2% with admission glucose 6.1 to 7.7 mmol/L, and 22.0% with admission glucose > 13.0 mmol/L (P < 0.001). Except in patients with admission glucose > 13.0 mmol/L, the 30-day mortality was significantly higher in patients without known diabetes than in patients with known diabetes at comparable admission glucose levels (all P < 0.05).</p><p><b>CONCLUSION</b>Comparing with the known diabetic patients, admission hyperglycemia is common in STEMI patients without known diabetes and was associated with higher 30-day mortality compared to known diabetes patients with comparable admission glucose level with the exception of admission glucose level > 13.0 mmol/L.</p>

Efficacy of intravenous Acehytisine Hydrochloride versus propafenone on terminating paroxysmal supraventricular tachycardia: a double-blinded, randomized multi-center study / 中华心血管病杂志

<p><b>OBJECTIVE</b>In this double-blinded, randomized, parallel study, we investigated the clinical efficacy of intravenous Acehytisine Hydrochloride (AHH) and propafenone on terminating paroxysmal supraventricular tachycardia (PSVT).</p><p><b>METHODS</b>Patients (18 - 70 years old) with either spontaneous or induced sustained supraventricular tachycardia lasted at least 15 min were recruited in this study. Exclusion criteria included sick sinus syndrome, atrial ventricular block or intraventricular block, etc. Eligible patients were randomly assigned to receive intravenously AHH (n=101) or propafenone (n=100) according to a proportion of 1:1 in a double-blinded manner. AHH (4 mg/kg, iv.) or propafenone (PRO, 1 mg/kg, iv.) was administered in 5 min followed by the same dose if no response was observed. Conversion times, vital signs, electrocardiograms were documented before and after drug administration.</p><p><b>RESULTS</b>Except for age, the demographic characteristics and clinical features were comparable between the two groups. Efficacy on PSVT termination was comparable between AHH (72/101, 71.3%) and PRO group (73/100, 73.0%, P=0.6368). The average time from drug administration to conversion was also similar [AHH: (9.62 +/- 8.39) min vs. PRO: (10.61 +/- 9.47) min, P=0.5035]. In the AHH group, 59/72 episodes of PSVT were terminated by the first dose, and 66/72 were terminated prematurely. The average AHH dose in the 72 converted patients was (273.7 +/- 111.2) mg. In the PRO group, 54/73 episodes of PSVT were terminated by the first dose. The electrocardiographic parameters, such as sinus recovery time, longest PP and RR interval, PR interval, QRS interval, QT interval after conversion were similar between the two groups. Transient adverse events were reported in 11/101 (10.9%) patients in the AHH group and in 18/100 (18.0%,) in the PRO group (P=0.1653).</p><p><b>CONCLUSION</b>With the dosage used in the present study, the efficacy on terminating PSVT was comparable between AHH and PRO.</p>

Electrophysiological effects of acehytisine hydrochloride in a porcine model of acute coronary occlusion / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the electrophysiological effect of Acehytisine Hydrochloride (AHH) in Wu Zhi Shan (WZS) micropigs with experimental acute coronary occlusion.</p><p><b>METHODS</b>Adult WZS micropigs were randomized into group A: coronary ligation with AHH infusion (n = 9); group B: AHH infusion without coronary ligation (n = 9) and group C: coronary ligation with saline (NS) infusion (n = 9). Surface ECGs and cardiac electrophysiological data including atrium, atrium-ventricle junction and ventricle electrograms were collected by programmed electrical stimulation at ischemic baseline and after AHH (or NS) infusion.</p><p><b>RESULTS</b>Compared to animals treated with AHH without ischemia, VARC-ERP was significantly increased while QT, QTc intervals, VRRP and VFRP were significantly reduced in ischemic animals treated with AHH. Compared to ischemic animals treated with saline, AHH prolongs the P-wave duration and PR interval, shortens QTc interval, prolongs ARP and AEP, also prolongs V-A reverse conduction time and VARC-ERP but shortens VFRP. No proarrhythmia effect was found in both AHH treated groups.</p><p><b>CONCLUSION</b>AHH resulted in significant electrophysiological effects on this porcine acute coronary ischemic model.</p>

Effect of different mulch materials on winter wheat production in desalinized soil in Heilonggang region of North China / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Freshwater shortage is the main problem in Heilonggang lower-lying plain, while a considerable amount of underground saline water is available. We wanted to find an effective way to use the brackish water in winter wheat production. Surface mulch has significant effect in reducing evaporation and decreasing soil salinity level. This research was aimed at comparing the effect of different mulch materials on winter wheat production. The experiment was conducted during 2002~2003 and 2003~2004. Four treatments were setup: (1) no mulch, (2) mulch with plastic film, (3) mulch with corn straw, (4) mulch with concrete slab between the rows. The result indicated that concrete mulch and straw mulch was effective in conserving soil water compared to plastic film mulch which increased soil temperature. Concrete mulch decreases surface soil salinity better in comparison to other mulches used. Straw mulch conserved more soil water but decreased wheat grain yield probably due to low temperature. Concrete mulch had similar effect with plastic film mulch on promoting winter wheat development and growth.

Effect of Guanfu Base A in patients with ventricular arrhythmias / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effect and safety of intravenous Guanfu Base A hydrochloride (GFA) in the treatment of ventricular arrhythmias.</p><p><b>METHODS</b>Patients without severe structural heart disease presenting with equal or more than 150 premature ventricular contractions per hour and/or non sustained ventricular tachycardia in drug-free holter monitoring were recruited in this double blind randomized active-controlled study. Eligible patients were randomly assigned to receive GFA or propafenone intravenously by a proportion of 1:1 in a double-blind manner. Intravenous bolus of the study medicine was given, followed by maintenance infusion for 6 hours. 24 hours continuous electrocardiographic recordings were performed to evaluate the efficacy. Vital signs, electrocardiograms and adverse events were documented before, during and after drug administration.</p><p><b>RESULTS</b>A total of 201 patients came from eight centres were randomized to GFA or propafenone group. The demographic characteristics, the extent of ventricular arrhythmias and baseline clinical findings were comparable between the two groups. There were no significant differences in the percentage of reducing premature ventricular contractions and the accumulated efficacy between two groups. GFA had tendency to be more effective than propafenone in reducing the number of ventricular ectopy (P = 0.0609). There were no significant differences in the onset of action after drug administration between two drugs. The tolerance of GFA was better than propafenone. The adverse events in GFA group were less severe than those in propafenone group.</p><p><b>CONCLUSIONS</b>Intravenous GFA in controlling the premature ventricular contraction has comparable effect to IV propafenone. Tolerance of GFA was better than propafenone.</p>

Effects of glucose and insulin on expression of scavenger receptor class B type Ⅰ in U937 macrophages / 中华内分泌代谢杂志

U937 macrophages were cultured with various concentrations of glucose and/or insulin for 24 h.Cell membrane scavenger receptor(SR)-BⅠprotein and mRNA were detected by Western blot and RT-PCR. The results showed that basal physiological insulin levels promoted SR-BⅠprotein expression of macrophages and high concentration of insulin significantly downregulated SR-BⅠ,but the transcription of SR-BⅠmRNA did not change.High glucose and high insulin accelerates atherosclerosis through synergetically downregulating SR-BⅠprotein expression,which may cause early onset and rapid progression of atherosclerosis in the patients with metabolic syndrome and type 2 diabetes mellitus.