ABSTRACT
Objective:To investigate the influence of infarct vessel diameter, blood flow before operation, blood flow status after operation, coronary artery disease, number of coronary artery lesions and other risk factors on the levels of inflammatory factors IL-1, IL-6, IL-10 in the coronary blood of patients with acute coronary syndrome (ACS), and to determine the relationship between inflammatory factors and ACS and its impact on clinical status.Methods:The peripheral blood and coronary blood of 54 patients with ACS underwent emergency interventional treatment were collected before the operation. The level of IL-1, IL-6, and IL-10 in the blood sample was detected by an automatic biochemical analyzer.Results:Postoperative adverse cardiac events were positively correlated with the patient's age, D-to-B time, and the number of coronary artery lesions (all P<0.05). The levels of IL-1, IL-6 and IL-10 in coronary blood of ACS patients were higher than those in peripheral blood (all P<0.05). The number of coronary artery disease branches (≥3), the onset time of myocardial infarction (>4 h), diabetes mellitus, ischemic post-treatment, preoperative blood flow level (<TIMI2 level) will increase the expression of IL-1 in serum (all P<0.05). For those who have no history of smoking, history of diabetes, infarct vessel diameter> 2.5 mm, coronary artery disease number ≥ 3, severe right coronary artery disease, preoperative blood flow <TIMI 2 level, postoperative CTFCs>22 frames, and cardiovascular events, the IL-10 levels are higher (all P<0.05). Conclusions:The levels of inflammatory factors IL-1, IL-6, and IL-10 in coronary blood of ACS patients are higher than those in peripheral blood, suggesting that acute coronary artery originates from local coronary inflammatory reaction, and the increase of inflammatory factors in peripheral blood belongs to "Erosion" effect. The level of inflammatory factors is significantly related to the diameter of the diseased blood vessel, preoperative blood flow, the number of coronary artery disease, the location of myocardial infarction, diabetes and smoking history.
ABSTRACT
Objective@#To evaluate the effect of the ischemic post-conditioning (IPC) on the prevention of the cardio-renal damage in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI).@*Methods@#A total of 251 consecutive STEMI patients underwent PPCI in the heart center of Tianjin Third Central Hospital from January 2012 to June 2014 were enrolled in this prospective, randomized, control, single-blinded, clinical registry study. Patients were randomly divided into IPC group (123 cases) and control group (128 cases) with random number table. Patients in IPC group underwent three times of inflation/deflation with low inflation pressure using a balloon catheter within one minute after culprit vessel blood recovery, and then treated by PPCI. Patients in control group received PPCI procedure directly. The basic clinical characteristics, incidence of reperfusion arrhythmia during the procedure, the rate of electrocardiogram ST-segment decline, peak value of myocardial necrosis markers, incidence of contrast induced acute kidney injury(CI-AKI), and one-year major adverse cardiovascular events(MACE) which including myocardial infarction again, malignant arrhythmia, rehospitalization for heart failure, repeat revascularization, stroke, and death after the procedure were analyzed between the two groups.@*Results@#The age of IPC group and control group were comparable((61.2±12.6) vs. (64.2±12.1) years old, P=0.768). The incidence of reperfusion arrhythmia during the procedure was significantly lower in the IPC group than in the control group(42.28% (52/123) vs. 57.03% (73/128), P=0.023). The rate of electrocardiogram ST-segment decline immediately after the procedure was significantly higher in the IPC group than in the control group (77.24% (95/123) vs. 64.84% (83/128), P=0.037). The peak value of myocardial necrosis markers after the procedure were significantly lower in the IPC group than in the control group(creatine kinase: 1 257 (682, 2 202) U/L vs. 1 737(794, 2 816)U/L, P=0.029; creatine kinase-MB: 123(75, 218)U/L vs.165(95, 288)U/L, P=0.010). The rate of CI-AKI after the procedure was significantly lower in the IPC group than in the control group(5.69%(7/123) vs. 14.06%(18/128), P=0.034). The rate of the one-year MACE was significantly lower in the IPC group than in the control group(7.32%(9/123) vs. 15.63% (20/128), P=0.040).@*Conclusion@#The IPC strategy performed eight before PPCI can reduce myocardial ischemia- reperfusion injury, decline the rates of CI-AKI and one-year MACE significantly in STEMI patients, thus has a significant protective effect on heart and kidney in STEMI patients. Clinical Trial Registration Chinese Clinical Trials Registry, ChiCTR-ICR-15006590.
ABSTRACT
Objective To explore the influence of smoking on clopidogrel resistance in patients with coro-nary artery disease. Methods A total of 216 patients with coronary artery disease who accept selective percutane-ous coronary intervention in our hospital from May 2015 to December 2015 were selected as study subjects;their average age was 63 years old ,146 were male and 70 were female. All the patients were divided into clopidogrel resistance group (CR group) and normal clopidogrel response group (NCR group) according to the results of platelet aggregation test. History of smoking ,alcohol drinking and diabetes mellitus ,baseline medication uses , level of platelet counts,platelet distribution width,mean platelet volume,HbA1c,and results of echocardiogram and coronary angiography were compared between the two groups. Results The rate of smoking was significantly higher in CR group than in NCR group (P < 0.05). The changed value of PDW before and after treatment with clopidogrel was smaller in CR group than in NCR group ,the difference was statistically significant (P < 0.05). Conclusions Smoking may be a protective factor for clopidogrel resistance. The changed value of PDW before and after treatment with clopidogrel can reflect the level of clopidogrel resistance.