Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province: A Multicenter Study.

BACKGROUND: Since 2010, two versions of National Guidelines aimed at promoting the management of ST-segment elevation myocardial infarction (STEMI) have been formulated by the Chinese Society of Cardiology. However, little is known about the changes in clinical characteristics, management, and in-hospital outcomes in rural areas. METHODS: In the present multicenter, cross-sectional study, participants were enrolled from rural hospitals located in Liaoning province in Northeast China, during two different periods (from June 2009 to June 2010 and from January 2015 to December 2015). Data collection was conducted using a standardized questionnaire. In total, 607 and 637 STEMI patients were recruited in the 2010 and 2015 cohorts, respectively. RESULTS: STEMI patients in rural hospitals were older in the second group (63 years vs. 65 years, P = 0.039). We found increases in the prevalence of hypertension, prior percutaneous coronary intervention (PCI), and prior stroke. Over the past 5 years, the cost during hospitalization almost doubled. The proportion of STEMI patients who underwent emergency reperfusion had significantly increased from 42.34% to 54.47% (P < 0.0001). Concurrently, the proportion of primary PCI increased from 3.62% to 10.52% (P < 0.0001). The past 5 years have also seen marked increases in the use of guideline-recommended drugs and clinical examinations. However, in-hospital mortality and major adverse cardiac events did not significantly change over time (13.01% vs. 10.20%, P = 0.121; 13.34% vs. 13.66%, P = 0.872). CONCLUSIONS: Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

Protective function of tocilizumab in human cardiac myocytes ischemia reperfusion injury.

OBJECTIVE: To investigate the protective function of tocilizumab in human cardiac myocytes ischemia-reperfusion injury. METHODS: The human cardiac myocytes were treated by tocilizumab with different concentrations(1.0 mg/mL, 3.0 mg/mL, 5.0 mg/mL) for 24 h, then cells were cultured in ischemia environment for 24 h and reperfusion environment for 1 h. The MTT and flow cytometry were used to detect the proliferation and apoptosis of human cardiac myocytes, respectively. The mRNA and protein expressions of Bcl-2 and Bax were measured by qRT-PCR and western blot, respectively. RESULTS: Compared to the negative group, pretreated by tocilizumab could significantly enhance the proliferation viability and suppress apoptosis of human cardiac myocytes after suffering ischemia reperfusion injury (P<0.05). The expression of Bcl-2 in tocilizumab treated group were higher than NC group (P<0.05), while the Bax expression were lower (P<0.05). CONCLUSIONS: Tocilizumab could significantly inhibit apoptosis and keep the proliferation viability of human cardiac myocytes after suffering ischemia reperfusion injury. Tocilizumab may obtain a widely application in the protection of ischemia reperfusion injury.

Anterolateral minithoracotomy versus median sternotomy for mitral valve disease: a meta-analysis.

OBJECTIVE: Mitral valve disease tends to be treated with anterolateral minithoracotomy (ALMT) rather than median sternotomy (MS), as ALMT uses progressively smaller incisions to promote better cosmetic outcomes. This meta-analysis quantifies the effects of ALMT on surgical parameters and post-operative outcomes compared with MS. METHODS: One randomized controlled study and four case-control studies, published in English from January 1996 to January 2013, were identified and evaluated. RESULTS: ALMT showed a significantly longer cardiopulmonary bypass time (P=0.001) and aortic cross-clamp time (P=0.05) compared with MS. However, the benefits of ALMT were evident as demonstrated by a shorter length of hospital stay (P<0.00001). According to operative complications, the onset of new arrhythmias following ALMT decreased significantly as compared with MS (P=0.05); however, the incidence of peri-operative mortality (P=0.62), re-operation for bleeding (P=0.37), neurologic events (P=0.77), myocardial infarction (P=0.84), gastrointestinal complications (P=0.89), and renal insufficiency (P=0.67) were similar to these of MS. Long-term follow-up data were also examined, and revealed equivalent survival and freedom from mitral valve events. CONCLUSIONS: Current clinical data suggest that ALMT is a safe and effective alternative to the conventional approach and is associated with better short-term outcomes and a trend towards longer survival.

Gender disparity in early death after ST-elevation myocardial infarction.

BACKGROUND: Females with acute myocardial infarction (AMI) have a higher risk of adverse outcomes because of receiving less evidence-based medical care. Our aim was to investigate the gender disparity in early death after ST-elevation myocardial infarction (STEMI) in the current era. METHODS: A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed. We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset. RESULTS: In the emergency reperfusion group (n = 754), in-hospital mortality occurred in 4.2% of the males and 11.2% of the females (P = 0.001). In the non-emergency reperfusion group (n = 675), in-hospital mortality occurred in 13.0% of the males and 22.9% of the females (P = 0.001). Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization (OR = 1.691, P = 0.007). After controlling for patients who died within 24 hr after admission, female sex was no longer an independent risk factor (OR = 1.409, P = 0.259). CONCLUSION: Female sex was an independent risk factor for in-hospital mortality of STEMI patients, which is explained by an excess of very early deaths.

[Ketamine inhalation before one-lung ventilation for perioperative lung protection in thoracic surgery patients].

OBJECTIVE: To explore the effects of ketamine inhalation before one-lung ventilation (OLV) in patients undergoing transthoracic esophagectomy for esophageal cancer. METHODS: Upon the approval of hospital ethic committee, 90 American Society of Anesthesiologists grade I-II patients scheduled for elective trans-left-thoracic esophagectomy for esophageal cancer were randomly and single-blindly divided into 3 groups. After intravenous anesthesia with double-lumen endobronchial intubation, the patients in each group received different therapies before OLV, i.e. inhaling ketamine 1 mg/kg in Group Ki, intravenous infusion of ketamine 1 mg/kg in Group Kv and inhaling normal saline 10 ml in Group C. Arterial blood gas analysis was performed. And (oxygen saturation) SpO2, (partial pressure of end-tidal carbon dioxide) PETCO2, (airway pressure) Paw and hemodynamic indicators were recorded at these points:before OLV (T1), OLV for 30 min (T2), OLV for 1 h (T3), OLV for 2 h (T4), OLV ended 5 min (T5) and end of surgery (T6). Central venous blood was sampled at T1, T2 and 2 h after surgery (T7) for the determination of interleukin-6 (IL-6), interleukin-8 (IL-8) and soluble intercellular adhesion molecule-1 (sICAM-1) concentrations by enzyme-linked immunosorbent assay (ELISA). RESULTS: Serum levels of IL-6, IL-8 and sICAM-1 in all groups increased significantly than those at previous timepoints. Serum levels of IL-6, IL-8 and sICAM-1 in Groups Ki and Kv were significantly lower than those in Group C at T7. PaO2 in Groups Ki and Kv was significantly higher than that in Group C at T4. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in Group Kv were significantly higher than that in Groups Ki and C at T2-T4; HR in Group Kv was significantly higher than that in Group C at T2-T3. Paw in Group Kv was significantly higher than that in Group C at T2-T6. CONCLUSION: Inhalation and intravenous infusion of ketamine before OLV are equally effective in lowering the serum levels of IL-6, IL-8 and sICAM-1. And ultrasonic atomizing inhalation of ketamine can avoid adverse effects on airway pressure and circulatory system caused by an intravenous infusion of ketamine.

Relationship between low-density lipoprotein levels on admission and 1-year outcome in patients with acute ST-segment-elevation myocardial infarction.

This study assessed the relationship between low-density lipoprotein cholesterol (LDL-C) levels on admission and the incidence of major adverse cardiovascular events (MACE) in patients with acute ST-segment-elevation myocardial infarction (ASTEMI). Patients with ASTEMI who had a lipid profile tested within 24 hours of symptom onset were enrolled. They were stratified into high and low LDL-C groups according to whether their LDL-C was above (n = 501) or below (n = 575) the median level, respectively. The incidence of MACE, cardiovascular death, non-fatal MI, revascularization, and stroke was compared between the groups at 1 month, 6 months, and 1 year. Survival analysis and Cox proportional hazard analysis were performed. In-hospital use of beta blockers was better in the high than in the low LDL-C group (76.6% vs. 69.7%, p = 0.01). Statin use was significantly higher in the high than in the low LDL-C group during follow-up (86.8% vs. 80.0%, p = 0.003 at1 month; 71.6% vs. 62.4%, p = 0.002 at 6 months; 67.8% vs. 61.2%, p = 0.03 at 1 year). The incidence of MACE on follow-up at 1 month was higher in the low than in the high LDL-C group (12.0% vs. 8.1%, p = 0.04). At 1 year, survival was not significantly different between the groups. Cox proportional hazards analysis indicated that the incidence of MACE was significantly associated with hypertension, current smoking, high-density lipoprotein cholesterol (HDL-C), in-hospital use of beta blockers, and statin use on follow-up (p < 0.01). LDL-C levels on admission in patients with ASTEMI had no significant effect on the 6-month and 1-year incidence of MACE, but the incidence of MACE was significantly higher in the low LDL-C group at 1 month. It would be relevant to further investigate the HDL-C level on admission, in-hospital use of beta blockers, and statin use during follow-up in relation to MACE.

[Effects of smoke on clinical prognosis of patients with acute ST-segment elevation myocardial infarction].

OBJECTIVE: To explore the effects of smoke on the clinical prognosis of patients with acute ST-segment elevation myocardial infarction (ASTEMI). METHODS: A total of 1213 consecutive ASTEMI patients were admitted into 20 hospitals in Liaoning province between May 2009 and May 2010. They were stratified into smoke (n = 588) and non-smoke (n = 625) groups. Basic demographic profiles, treatment data and clinical outcomes were compared between two groups. The primary endpoint was cardiac death and the secondary endpoints included non-fatal myocardial infarction, stroke and revascularization. Cox proportional hazard analyses were performed. RESULTS: The proportion of percutaneous coronary intervention (PCI) in the smoke group was significantly higher than that in the non-smoke group (40.8% vs 22.1%, P < 0.001). During the follow-up period, the medication rate was significantly higher in the smoke group than that in the non-smoke group (aspirin: 75.3% vs 62.2%, P < 0.001; clopidogrel: 40.5% vs 32.2%, P = 0.003; ß receptor blockade: 45.4% vs 36.0%, P = 0.001; angiotensin-converting-enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB): 38.3% vs 32.2%, P = 0.026; statins: 57.3% vs 44.2%, P < 0.001). During the follow-up period, the rate of cardiac death was lower in the smoke group than that in the non-smoke group (10.2% vs 24.2%, P < 0.001). No significant differences existed between two groups. During the follow-up period, the rate of cardiac death was significantly correlated with smoke (HR 2.777, 95%CI 1.113 - 6.928, P = 0.029), PCI (HR 0.208, 95%CI 0.062 - 0.700, P = 0.011), age (HR 1.049, 95%CI 1.005 - 1.095, P = 0.028), aspirin (HR 0.165, 95%CI 0.061 - 0.446, P < 0.001) and statins (HR 0.382, 95%CI 0.317 - 0.462, P < 0.001). CONCLUSION: Among the ASTEMI patients, the rate of cardiac death is significantly lower in the smoke group than that in the non-smoke group. And it is significantly correlated with such independent risk factors as smoke, PCI, age, aspirin and statins.

[Ridge regression analysis of pulmonary infection rate after transthoracic esophagectomy for esophageal cancer].

OBJECTIVE: To identify the influencing factors of pulmonary infections after transthoracic esophagectomy for esophageal cancer. METHODS: A retrospective review of 349 patients undergoing transthoracic esophagectomy at our hospital for esophageal cancer was performed between January and December 2009. The postoperative pneumonia rate was examined and 26 perioperative factors possibly affecting the postoperative respiratory complications were collected. Ridge regression modeling was performed to determine if a significant association existed between perioperative factors and postoperative pneumonia. RESULTS: The postoperative pneumonia rate of all patients was 27.8%. Eight perioperative factors were found to have affected significantly the postoperative respiratory complications. The influencing factors included (according to contribution): patient control epidural analgesia (PCEA), diabetes, general anesthesia plus epidural analgesia, other postoperative complications, one lung ventilation (OLV), transfusion volume of red blood cells (RBC), body mass index (BMI) and age. CONCLUSION: The major influencing factors of pulmonary infection after transthoracic esophagectomy for esophageal cancer are PCEA, diabetes, general anesthesia plus epidural analgesia, other postoperative complications, OLV, transfusion volume of RBC, BMI and age.

Prospective multi-center study of female patients with ST-elevation myocardial infarction in Liaoning province, China.

BACKGROUND: In cardiology, it is controversial whether gender influences prognosis after acute myocardial infarction (MI). We examined the 30-day and 1-year prognosis for female patients with ST-elevation myocardial infarction (STEMI) in Liaoning province, and we analyzed factors that influenced these outcomes. METHODS: This was a prospective, multicenter, observational study in which patient data were collected by questionnaire at the time of diagnosis and at approximately 30 days and 1 year later by telephone inquiries. Patients were diagnosed with STEMI between June 1, 2009 and June 1, 2010 at any of the 20 hospitals that gave treatment representative of current STEMI treatment in Liaoning Province. Unified follow-up questionnaire was used to visit the STEMI patients. RESULTS: We analyzed data from a total of 1429 consecutive patients with STEMI in Liaoning province. Female patients were older (70.0 vs. 60.3, P < 0.001) and were less likely to receive emergency reperfusion therapy than male ones (39.2% vs. 58.0%, P < 0.001). Female gender was associated with higher unadjusted 30-day mortality rates (HR = 2.118, 95%CI: 1.572 - 2.854, P < 0.001) and higher unadjusted 1-year mortality rates (HR = 2.174, 95%CI: 1.659 - 2.848, P < 0.001). Multivariate Cox regression analysis showed that female gender was not an independent predictor of 30-day mortality rates (HR = 1.273, 95%CI: 0.929 - 1.745, P = 0.133) nor of 1-year mortality rates (HR = 1.112, 95%CI: 0.831 - 1.487, P = 0.475). CONCLUSIONS: Women with STEMI appear to be at increased risk of 30-day and 1-year mortality compared with male STEMI patients, but this difference may be explained by older age and less frequent receipt of reperfusion therapy among the women.

[Impact of high-density lipoprotein levels at hospital admission on the outcome of patients with acute ST-segment elevation myocardial infarction].

OBJECTIVE: To analyze the impact of high-density lipoprotein cholesterol (HDL-C) levels at hospital admission on the incidence of major adverse cardiovascular events (MACCE) in patients with acute ST segment elevation myocardial infarction (ASTEMI). METHODS: 1067 patients with ASTEMI who were admitted to the 20 hospitals in Liaoning region and with lipid profile tested within the 24 hours of admission from May 2009 until May 2010, were enrolled. Data on basic demographic, clinical, status on admission and method of treatment were collected. Rate on various medical use and MACCE (cardiovascular death, non-fatal myocardial infarction, revascularization and stoke) were compared between the two groups through follow-up observation. Cox proportional hazard analysis was estimation. RESULTS: The median HDL-C level was 1.27 mmol/L, with 587 patients having HDL-C below and 489 patients HDL-C above the median level. The incidence rates of non-fatal myocardial infarction and MACCE at one-year follow-up period, was higher in low HDL-C group (4.8% vs. 0.9%, P<0.001; 23.7% vs. 18.1%, P=0.03, respectively). At one month follow-up, the incidence rate of non-fatal myocardial infarction was higher in low HDL-C group (1.4% vs. 0.0%, P=0.01). At six month follow-up, the incidence rates of non-fatal myocardial infarction and MACCE on one-year follow-up was higher in low HDL-C group (2.8% vs. 0.4%, P=0.003; 18.3% vs. 13.7%, P=0.04, respectively). RESULTS: from Cox proportional hazards analysis indicated that age (HR=1.02, 95%CI: 1.006-1.035, P=0.005), diabetes (HR=1.05, 95%CI: 1.053-2.171, P=0.03), HDL-C level (HR=0.56, 95%CI: 0.340-0.921, P=0.02) were significantly related to the incidence of MACCE. CONCLUSION: The incidence rates of one year and six month MACCE (mainly non-fatal myocardial infarction) and one month non-fatal myocardial infarction were significant higher in patients with low than high HDL-C levels at admission while kept on the ascending along with time. Age, diabetes, HDL-C level were independent risk factors related to the incidence of MACCE.

[The role of gender difference on the prognosis of ST-segment elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention].

OBJECTIVE: To investigate and analyze the impact of gender difference on outcome and prognosis of ST-segment elevation myocardial infarction (STEMI) in patients treated with primary percutaneous coronary intervention (PCI). METHODS: This was a prospective and multicentered observation study. All the patients with acute STEMI admitted to the hospitals from June 1(st) 2009 to June 1(st) 2010 were continuously recruited. In this study, a unified questionnaire was applied and the 382 patients satisfied the criteria. A unified follow-up questionnaire was used on patients who were discharged from the hospital. RESULTS: On average, the female patients were 8 years older than the males. The median "symptom-to-balloon time" was 312.5 minutes in females and 270.0 minutes in males, and it was significantly different (P = 0.007). During hospitalization, a higher proportion of female patients developed heart failure, angina and bleeding. No gender differences were found on the in-hospital mortality rates and medical therapy recommended by the guideline. The female patients were more prone to multi-vessel disease than males (P = 0.002). Success rates of primary PCI did not show any gender differences. One-month mortality and other cardiovascular events also did not show gender difference when the patients were followed for one month after being discharged. The rates of heart failure and re-hospitalization due to cardiac incidents among female patients were obviously higher than the males, three months after being discharged (P = 0.007, respectively). However, the three-month and long-term cardiac mortality did not show differences related to gender. Female patients were associated with higher all-cause mortality than that in males, but there was no statistically significant difference (female 4.2% vs. male 1.6%; P = 0.056). Data from multi-factor regression analysis showed that being female was not an independent predictor related to in-hospital mortality or during the follow-up period. CONCLUSION: Being female was not an independent predictor of in-hospital mortality or during follow-up period among patients who were treated with primary PCI. Worse long-term outcome seen in female patients was likely to be explained by older age or longer pre-hospital delayed time.

Increased poly(ADP-ribosyl)ation in peripheral leukocytes and the reperfused myocardium tissue of rats with ischemia/reperfusion injury: prevention by 3-aminobenzamide treatment.

The overactivation of the nuclear enzyme poly(ADP-ribose) polymerase (PARP) is considered a final common effector in ischemia/reperfusion (I/R) injury. The aim of the current study was to examine the precise time course of the activation of PARP in peripheral leukocytes and the reperfused myocardium tissue on myocardial I/R injury from the same rat and to identify the relationship between myocardial infarct size and the degree of PARP activation in circulating leukocytes. Another aim of the study was to test the effect of 3-aminobenzamide (a well-known and widely used PARP inhibitor) on the activation of PARP in the reperfused myocardium and peripheral leukocytes. Poly(ADP-ribose) polymerase activation was measured by Western blotting for its product, poly(ADP-ribose) (PAR). The localization of PARP activation was determined by PAR immunohistochemistry. The results showed that poly(ADP-ribosyl)ation was detected 15 min, peaked 2 to 6 h, and remained markedly detectable 24 h in the reperfused heart after I/R model. Similarly, PAR content of the leukocytes increased in cells isolated just after reperfusion from the same rat. Immunohistochemical studies localized the staining of PAR primarily to the cardiac myocytes and vascular endothelial cells. At 6 h, there was a significant linear correlation between infarct size and PARP activity, whereas at 2 and 24 h, no relationship was found. The PARP inhibitor 3-aminobenzamide (3-AB, 20 mg kg⁻¹ i.v. injection 15 min before reperfusion, and every 2 h thereafter for 6 h) markedly reduced infarct size through depressing the activation of the enzyme in myocytes and peripheral leukocytes even when the treatment is initiated at 2 h after reperfusion.

[The impact of body mass index on the presentation, treatment and clinical outcomes of patients with ST-segment elevated myocardial infarction].

OBJECTIVE: To analyze the impact of body mass index (BMI) on the presentation, treatment, and clinical outcomes of patients with ST-segment elevated myocardial infarction (STEMI). METHODS: 1414 patients with STEMI who were admitted to the 20 hospitals in Liaoning region from May 2009 until May 2010 were enrolled. Patients were stratified according to the BMI levels as normal weight group (18.5 kg/m(2) ≤ BMI < 24.0 kg/m(2)) (n = 485), overweight (24.0 kg/m(2) ≤ BMI < 28.0 kg/m(2)) (n = 736), or obesity (BMI ≥ 28.0 kg/m(2)) (n = 193). Presentation, treatment and mortality during hospitalization, MACCE (cardiovascular death, non-fatal myocardial infarction, revascularization and stroke) were compared between the three groups at 3-month and 1-year follow-up. RESULTS: Obesity in patients with STEMI was associated with younger age (P < 0.001), being male (P < 0.001), with diabetes (P = 0.013) or hypertension (P < 0.001) and hyperlipidmia (P < 0.001). A higher prevalence of reperfusion treatment (P = 0.018), mainly percutaneous coronary intervention (PCI) (P < 0.001) was seen during the period of hospitalization. Rates of using other kinds of medicines as well as the mortalities during hospitalization, were similar among the groups with different BMI categories. At 3-month and 1-year follow-up, more use of asprin (3-months: P = 0.018; 1-year: P = 0.002) and ß-receptor blockers were seen in the obesity group (3-months: P = 0.025; 1-year: P = 0.030) while the use of other drugs were not significantly different among the three groups. The incidence rates of MACCE were not significantly different among the BMI categories while the cumulative survival rate was similar between obese group and normal weight group. Results from the Cox proportional hazards analysis indicated that factors as age (HR = 1.045, 95%CI: 1.028-1.062, P < 0.001), diabetes (HR = 1.530, 95%CI: 1.107 - 2.301, P = 0.041), hyperlipidmia (HR = 2.127, 95%CI: 1.317 - 3.435, P = 0.002), urgent PCI (HR = 0.473, 95%CI: 0.307 - 0.728, P = 0.001) and the use of ß-receptor blockers at 3-months follow-up period (HR = 0.373, 95%CI: 0.195 - 0.713, P = 0.003) were significantly related to the incidence of MACCE at 1-year follow-up period. CONCLUSION: Despite the fact that patients with obesity presented with STEMI at younger age and having received active treatment of reperfusion and medicine, both the 3-month and 1-year outcomes did not show significant difference among the BMI categories.

Myocardial infarction in a patient with systemic lupus erythematosus and antiphospholipid syndrome.

This case report we presented aims to report a-31-year-old man with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) who developed myocardial infarction (MI) and also aims to discuss the possible mechanisms. The results showed that traditional risk factors alone do not cause coronary heart disease with SLE, and SLE-related factors influence the atherogenic process. We found that although SLE patients with acute MI benefit from percutaneous coronary intervention (PCI) therapy, it is very important to choose the reasonable antithrombotic strategies in patients with SLE and APS undergoing PCI who require oral anticoagulant therapy.

[Onset timing of acute ST segment elevation myocardial infarction in middle-aged and old patients].

OBJECTIVE: To compare the differences on onset timing of acute ST segment elevation myocardial infarction (STEMI) in young and aged patients. METHODS: The exact onset time of symptoms was obtained from 1024 consecutive patients with STEMI admitted to our hospital between January 2000 and May 2010. Patients were classified as the middle-aged group [< 65 years old, mean (52.2 ± 8.0) years, n = 536] and old group [≥ 65 years old, (72.2 ± 5.5) years, n = 488], the difference of the onset months, weeks, weekdays and hours between two groups was compared. RESULTS: The high onset timing of STEMI in middle-aged group was October and February, Friday, Saturday and Wednesday, at 10 A.m. and 10 P.m. The high onset timing of STEMI in old group was October, January and March, Friday, Sunday and Monday, at 6 A.m. and 2 A.m. The incidences of STEMI in the old group were significant higher than in the middle-aged group in March (11.89%), on Sunday (15.97%) and Monday (17.42%), at 6 A.m. (6.35%) and 2 A.m. (5.74%) (all P < 0.05) while the onset rate was significant higher in February (9.89%), On Saturday (16.98%), At 8 P.m. (4.86%) and 10 P.m. (5.78%) in the middle-aged group than old group (all P < 0.05). CONCLUSION: The onset timing of STEMI in old patients was significant different from the middle-aged patients suggesting the onset timing of STEMI changes with aging.