1
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Attar A, Namvar S, Hosseinpour A, Azami P, Shekari A, Jamali L, Goudarzi N. Effect of different reperfusion strategies on recovery of ventricular function after ST-segment elevation myocardial infarction: A longitudinal single-center study. Health Sci Rep 2024; 7:e2220. [PMID: 38933425 PMCID: PMC11199175 DOI: 10.1002/hsr2.2220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/09/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background and Aims Although the clinical benefit of percutaneous coronary intervention (PCI) on cardiovascular outcomes has been widely investigated, the impact of this revascularization strategy compared to other alternatives on the degree of left ventricular function recovery is poorly demonstrated. In this regard, we investigated whether time delays between the presentation of ST-segment elevation myocardial infarction (STEMI) and PCI in reperfusion strategies have different impacts on left ventricular function recovery. Methods In this single-center study, all the patients who presented with STEMI and a reduced left ventricular ejection fraction (LVEF ≤ 40%) were enrolled. Included patients were subjected to four different treatment groups of primary, rescue (immediate transfer for angioplasty due to failed fibrinolytic therapy), facilitated (fibrinolytic therapy followed by angioplasty within 24 h), and deferred (successful fibrinolytic therapy and PCI after 24 h) PCI based on hospital facilities. Echocardiography was performed for all the patients at the time of hospitalization and 6 months later. Results A total of 128 patients were included in this study. The LVEF improved by 15.3 ± 6.3%, 11.5 ± 3.61%, 4.0 ± 1.0%, and -1.3 ± 7.0% in primary, rescue, facilitated, and deferred PCI groups, respectively (p < 0.001). Patients undergoing deferred PCI experienced a significantly lower improvement in LVEF compared with primary and rescue PCI (p < 0.001). Conclusion Primary PCI demonstrated the most promising recovery in left ventricular function following STEMI compared to other alternative strategies. Performing PCI as soon as possible provides better recovery of LVEF.
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Affiliation(s)
- Armin Attar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Soheila Namvar
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Alireza Hosseinpour
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
- School of MedicineShiraz University of Medical SciencesShirazIran
| | - Pouria Azami
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Arash Shekari
- Cardiovascular Diseases Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Leila Jamali
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
| | - Neda Goudarzi
- Department of Cardiovascular Medicine, TAHA Clinical Trial GroupShiraz University of Medical SciencesShirazIran
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2
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Okada K, Hibi K, Kikuchi S, Kirigaya H, Hanajima Y, Sato R, Nakahashi H, Minamimoto Y, Matsuzawa Y, Maejima N, Iwahashi N, Kosuge M, Ebina T, Tamura K, Kimura K. Culprit Lesion Morphology of Rapidly Progressive and Extensive Anterior-Wall ST-Segment Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2022; 15:e014497. [PMID: 36378775 DOI: 10.1161/circimaging.122.014497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rapidly progressive, extensive myocardial injury/infarction (RPEMI) beyond the concept of wave-front phenomenon can be observed even when achieving timely reperfusion; however, the pathogenesis of RPEMI remains unknown. This retrospective study investigated clinical and lesion characteristics of RPEMI, focusing on culprit-lesion morphology (CLM). METHODS Among patients with extensive anterior-wall ST-segment elevation myocardial infarction due to proximal left anterior descending artery lesions who had reperfusion within 3 hours of symptom onset, 60 patients undergoing both intravascular ultrasound and cardiac magnetic resonance imaging were enrolled. Myocardial injury/infarction before reperfusion therapy was assessed by QRS scores at hospitalization electrocardiogram, and the extent of myocardial injury/infarction was evaluated by cardiac magnetic resonance imaging, which measured area at risk, infarct size, myocardial salvage index, microvascular obstruction, and left ventricular ejection fraction. RPEMI was defined as lower left ventricular ejection fraction (less median value) with microvascular obstruction. RESULTS Despite comparable onset-to-door and onset-to-reperfusion times and area at risk, patients with RPEMI showed higher QRS scores at hospitalization (5 [4.3-6] versus 3 [2-4], P<0.001) and infarct size (26.5±9.1 versus 20.4±10.5%, P=0.04), and a tendency toward lower myocardial salvage index (0.27±0.14 versus 0.36±0.20, P=0.10) compared with those without. Patients with versus without RPEMI more frequently observed specific CLM on intravascular ultrasound, characterized by the combination of vulnerable plaques, plaque ruptures, and/or large thrombi. When stratified by CLM-score composed of these 3 criteria, higher CLM-scores were or tended to be associated with higher QRS scores and incidence of RPEMI. In multivariate analyses including no-reflow phenomenon and final coronary-flow deterioration, increased CLM-score (≥2) was independently associated with high QRS scores and RPEMI (odd ratio 11.25 [95% CI, 2.43-52.00]; P=0.002). CONCLUSIONS Vulnerable CLM was a consistent determinant of advanced myocardial injury/infarction both before and after reperfusion therapy and may play a pivotal role in the development of RPEMI.
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Affiliation(s)
- Kozo Okada
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | | | - Hidekuni Kirigaya
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yohei Hanajima
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Ryosuke Sato
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | | | - Yugo Minamimoto
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Nobuhiko Maejima
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Toshiaki Ebina
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kouichi Tamura
- Division of Cardiology, Yokohama City University Medical Center, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan
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3
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Reconsidering treatment guidelines for acute myocardial infarction during the COVID-19 pandemic. BMC Cardiovasc Disord 2022; 22:194. [PMID: 35473672 PMCID: PMC9040353 DOI: 10.1186/s12872-022-02626-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background COVID-19 affects healthcare resource allocation, which could lead to treatment delay and poor outcomes in patients with acute myocardial infarction (AMI). We assessed the impact of the COVID-19 pandemic on AMI outcomes. Methods We compared outcomes of patients admitted for acute ST-elevation MI (STEMI) and non-STEMI (NSTEMI) during a non-COVID-19 pandemic period (January–February 2019; Group 1, n = 254) and a COVID-19 pandemic period (January–February 2020; Group 2, n = 124). Results For STEMI patients, the median of first medical contact (FMC) time, door-to-balloon time, and total myocardial ischemia time were significantly longer in Group 2 patients (all p < 0.05). Primary percutaneous intervention was performed significantly more often in Group 1 patients than in Group 2 patients, whereas thrombolytic therapy was used significantly more often in Group 2 patients than in Group 1 patients (all p < 0.05). However, the rates of and all-cause 30-day mortality and major adverse cardiac event (MACE) were not significantly different in the two periods (all p > 0.05). For NSTEMI patients, Group 2 patients had a higher rate of conservative therapy, a lower rate of reperfusion therapy, and longer FMC times (all p < 0.05). All-cause 30-day mortality and MACE were only higher in NSTEMI patients during the COVID-19 pandemic period (p < 0.001). Conclusions COVID-19 pandemic causes treatment delay in AMI patients and potentially leads to poor clinical outcome in NSTEMI patients. Thrombolytic therapy should be initiated without delay for STEMI when coronary intervention is not readily available; for NSTEMI patients, outcomes of invasive reperfusion were better than medical treatment.
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4
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Buja LM, Schoen FJ. The pathology of cardiovascular interventions and devices for coronary artery disease, vascular disease, heart failure, and arrhythmias. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00024-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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5
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Oliveira JC, Ferreira GJDS, Oliveira JC, Lima TCRM, Barreto IDDC, Oliveira LCS, Arcelino LAM, Sousa AC, Barreto-Filho JAS. Influence of Geographical Location on Access to Reperfusion Therapies and Mortality of Patients with STEMI in Sergipe: VICTIM Register. Arq Bras Cardiol 2021; 117:120-129. [PMID: 34320081 PMCID: PMC8294745 DOI: 10.36660/abc.20200015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/04/2020] [Accepted: 08/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The concentration of high-complexity services in Aracaju, Sergipe can impose certain disparity in the quality of care for the patients with ST-segment elevation acute myocardial infarction (STEMI) (STEMI) who receive care from Brazil's Unified Health System (SUS, acronym in Portuguese) and whose symptoms started in other health regions of the state. OBJECTIVE To evaluate disparities in access to reperfusion therapies and 30-day mortality, among patients with STEMI, who were users of SUS, in each of the 7 health regions of Sergipe. METHODS A total of 844 patients with STEMI in the period from 2014 to 2018, assisted by the only hospital with the capacity to offer primary percutaneous coronary intervention (PPCI) to SUS users in the state of Sergipe, were evaluated. The patients were divided into 7 groups according to the location at the onset of symptoms, following the existing division of health regions in the state. For comparison between groups, a significant difference was considered when p < 0.05. RESULTS Of the total of 844 patients suffering from STEMI who were transferred to the hospital with PPCI that serves SUS patients, 386 patients (45.8%) underwent primary angioplasty. The mean rate of fibrinolytic use was 2.6%, with no differences between the regions. The mean total time of arrival to the hospital with PPCI was 21 hours and 55 minutes, with a median of 10 hours and 22 minutes (6 hours and 30 minutes to 22 hours and 52 minutes). Total 30-day mortality was 12.8%, but without differences between the regions, even when adjusted for age and sex. CONCLUSIONS This study reveals that fibrinolytics are underused throughout the state and that there is a significant delay in access to the hospital with PPCI, in all health regions of Sergipe.
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Affiliation(s)
- Jeferson Cunha Oliveira
- Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe -
Programa de Pós-Graduação em Ciências da Saúde
da
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
- Hospital PrimaveraAracajuSEBrasil
Hospital Primavera
,
Aracaju
,
SE
-
Brasil
| | | | - Jussiely Cunha Oliveira
- Universidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
| | - Ticiane Clair Remacre Munareto Lima
- Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe -
Programa de Pós-Graduação em Ciências da Saúde
da
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
| | - Ikaro Daniel de Carvalho Barreto
- Universidade Federal Rural de PernambucoNúcleo de Pós-graduação em Biometria e Estatística AplicadaRecifePEBrasil
Universidade Federal Rural de Pernambuco
-
Núcleo de Pós-graduação em Biometria e Estatística Aplicada
,
Recife
,
PE
-
Brasil
| | - Laís Costa Souza Oliveira
- Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe -
Programa de Pós-Graduação em Ciências da Saúde
da
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
- Hospital PrimaveraAracajuSEBrasil
Hospital Primavera
,
Aracaju
,
SE
-
Brasil
| | - Larissa Andreline Maia Arcelino
- Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe -
Programa de Pós-Graduação em Ciências da Saúde
da
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
- Hospital UniversitárioUniversidade Federal de SergipeAracajuSEBrasil
Hospital Universitário
da
Universidade Federal de Sergipe
(HU-UFS),
Aracaju
,
SE
-
Brasil
| | - Antônio Carlos Sousa
- Universidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
| | - José Augusto Soares Barreto-Filho
- Programa de Pós-Graduação em Ciências da SaúdeUniversidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe -
Programa de Pós-Graduação em Ciências da Saúde
da
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
- Universidade Federal de SergipeSão CristóvãoSEBrasil
Universidade Federal de Sergipe
,
São Cristóvão
,
SE
-
Brasil
- Fundação São Lucas - Centro de Ensino e PesquisaAracajuSEBrasil
Fundação São Lucas - Centro de Ensino e Pesquisa
,
Aracaju
,
SE
–
Brasil
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6
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Rinfret S, Jahan I, McKenzie K, Dendukuri N, Bainey KR, Mansour S, Natarajan M, Ybarra LF, Chong AY, Bérubé S, Breton R, Curtis MJ, Rodés-Cabau J, Amlani S, Bagherli A, Ball W, Barolet A, Beydoun HK, Brass N, Chan AW, Colizza F, Constance C, Fam NP, Gobeil F, Haghighat T, Hodge S, Joyal D, Kim HH, Lutchmedial S, MacDougall A, Malik P, Miner S, Minhas K, Orvold J, Palisaitis D, Parfrey B, Potvin JM, Puley G, Radhakrishnan S, Spaziano M, Tanguay JF, Vijayaraghaban R, Webb JG, Zimmermann RH, Wood DA, Brophy JM. COVID-19 pandemic and coronary angiography for ST-elevation myocardial infarction, use of mechanical support and mechanical complications in Canada; a Canadian Association of Interventional Cardiology national survey. CJC Open 2021; 3:1125-1131. [PMID: 33997751 PMCID: PMC8114614 DOI: 10.1016/j.cjco.2021.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 11/15/2022] Open
Abstract
Background As a result of the COVID-19 pandemic first wave, reductions in ST-elevation myocardial infarction (STEMI) invasive care, ranging from 23% to 76%, have been reported from various countries. Whether this change had any impact on coronary angiography (CA) volume or on mechanical support device use for STEMI and post-STEMI mechanical complications in Canada is unknown. Methods We administered a Canada-wide survey to all cardiac catheterization laboratory directors, seeking the volume of CA use for STEMI performed during the period from March 1 2020 to May 31, 2020 (pandemic period), and during 2 control periods (March 1, 2019 to May 31, 2019 and March 1, 2018 to May 31, 2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects and papillary muscle rupture cases diagnosed, was also recorded. We also assessed whether the number of COVID-19 cases recorded in each province was associated with STEMI-related CA volume. Results A total of 41 of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (incidence rate ratio [IRR] 0.84; 95% confidence interval 0.80-0.87) in CA for STEMI during the first wave of the pandemic, compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95% confidence interval 0.61-0.89) in the use of intra-aortic balloon pump use for STEMI. Use of an Impella pump and mechanical complications from STEMI were exceedingly rare. Conclusions We observed a modest 16% decrease in use of CA for STEMI during the pandemic first wave in Canada, lower than the level reported in other countries. Provincial COVID-19 caseload did not influence this reduction.
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Affiliation(s)
- Stéphane Rinfret
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
| | - Israth Jahan
- Department of medicine and biostatistics, McGill University Health Centre, McGill University, Montreal, QC
| | | | - Nandini Dendukuri
- Department of medicine and biostatistics, McGill University Health Centre, McGill University, Montreal, QC
| | - Kevin R Bainey
- Division of cardiology, Mazankowski Alberta Heart Institute, Edmonton, AB
| | - Samer Mansour
- Division of cardiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC.,Division of cardiology, Hôpital de la Cité-de-la-Santé, Laval, QC
| | - Madhu Natarajan
- Division of cardiology, Hamilton Health Sciences Centre, Hamilton, ON
| | - Luiz F Ybarra
- Division of cardiology, London Health Sciences Centre, London, ON
| | - Aun-Yeong Chong
- Division of cardiology, University of Ottawa Heart Institute, Ottawa, ON
| | - Simon Bérubé
- Division of cardiology, CIUSSS de l'Estrie - CHUS, Sherbrooke, QC
| | - Robert Breton
- Division of cardiology, CIUSSS Saguenay Lac Saint Jean, Saguenay, QC
| | | | - Josep Rodés-Cabau
- Multidisciplinary department of cardiology, Institut universitaire de cardiologie et de pneumologie de Québec-Hôpital Laval, Quebec City, QC
| | - Shy Amlani
- Division of cardiology, William Osler Health System, Brampton, ON
| | | | - Warren Ball
- Division of cardiology, Peterborough Regional Health Centre, Peterborough, ON
| | - Alan Barolet
- Division of cardiology, University Health Network - Toronto General Hospital, Toronto, ON
| | | | - Neil Brass
- Division of cardiology, CK Hui Heart Centre/Royal Alexandra Hospital, Edmonton, AB
| | - Albert W Chan
- Division of cardiology, Royal Columbian Hospital, New Westminster, BC
| | - Franco Colizza
- Division of cardiology, Centre Hospitalier Pierre-Boucher, Longueuil, QC
| | | | - Neil P Fam
- Division of cardiology, St. Michael's Hospital, Montreal, QC
| | - François Gobeil
- Division of cardiology, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | | | - Steven Hodge
- Division of cardiology, Kelowna General Hospital, Kelowna, BC
| | - Dominique Joyal
- Division of cardiology, Jewish General Hospital, Montreal, QC
| | - Hahn Hoe Kim
- Division of cardiology, St-Mary's Regional Cardiac Care Centre, Kitchener-Waterloo, ON
| | | | - Andrea MacDougall
- Division of cardiology, Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON
| | - Paul Malik
- Division of cardiology, Kingston General Hospital, Kingston, ON
| | - Steve Miner
- Division of cardiology, Southlake Regional Health Centre, Newmarket, ON
| | - Kunal Minhas
- Division of cardiology, St. Boniface General Hospital, Winnipeg, MB
| | - Jason Orvold
- Division of cardiology, Royal University Hospital, Saskatoon, SK
| | | | - Brendan Parfrey
- Division of cardiology, Health Sciences Center, St-John's, NF
| | | | - Geoffrey Puley
- Division of cardiology, Trillium Health Centre, Mississauga, ON
| | - Sam Radhakrishnan
- Division of cardiology, Sunnybrook Health Sciences Centre, Toronto, ON
| | - Marco Spaziano
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
| | | | | | - John G Webb
- Division of cardiology, St. Paul's Hospital, Vancouver BC
| | | | - David A Wood
- Division of cardiology, Vancouver General Hospital, Vancouver, BC
| | - James M Brophy
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, QC
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7
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Zhang MW, Shen YJ, Shi J, Yu JG. MiR-223-3p in Cardiovascular Diseases: A Biomarker and Potential Therapeutic Target. Front Cardiovasc Med 2021; 7:610561. [PMID: 33553260 PMCID: PMC7854547 DOI: 10.3389/fcvm.2020.610561] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Cardiovascular diseases, involving vasculopathy, cardiac dysfunction, or circulatory disturbance, have become the major cause of death globally and brought heavy social burdens. The complexity and diversity of the pathogenic factors add difficulties to diagnosis and treatment, as well as lead to poor prognosis of these diseases. MicroRNAs are short non-coding RNAs to modulate gene expression through directly binding to the 3′-untranslated regions of mRNAs of target genes and thereby to downregulate the protein levels post-transcriptionally. The multiple regulatory effects of microRNAs have been investigated extensively in cardiovascular diseases. MiR-223-3p, expressed in multiple cells such as macrophages, platelets, hepatocytes, and cardiomyocytes to modulate their cellular activities through targeting a variety of genes, is involved in the pathological progression of many cardiovascular diseases. It participates in regulation of several crucial signaling pathways such as phosphatidylinositol 3-kinase/protein kinase B, insulin-like growth factor 1, nuclear factor kappa B, mitogen-activated protein kinase, NOD-like receptor family pyrin domain containing 3 inflammasome, and ribosomal protein S6 kinase B1/hypoxia inducible factor 1 α pathways to affect cell proliferation, migration, apoptosis, hypertrophy, and polarization, as well as electrophysiology, resulting in dysfunction of cardiovascular system. Here, in this review, we will discuss the role of miR-223-3p in cardiovascular diseases, involving its verified targets, influenced signaling pathways, and regulation of cell function. In addition, the potential of miR-223-3p as therapeutic target and biomarker for diagnosis and prediction of cardiovascular diseases will be further discussed, providing clues for clinicians.
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Affiliation(s)
- Meng-Wan Zhang
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yun-Jie Shen
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Shi
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jian-Guang Yu
- Department of Pharmacy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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8
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Puhr-Westerheide D, Schink SJ, Fabritius M, Mittmann L, Hessenauer MET, Pircher J, Zuchtriegel G, Uhl B, Holzer M, Massberg S, Krombach F, Reichel CA. Neutrophils promote venular thrombosis by shaping the rheological environment for platelet aggregation. Sci Rep 2019; 9:15932. [PMID: 31685838 PMCID: PMC6828708 DOI: 10.1038/s41598-019-52041-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/12/2019] [Indexed: 12/24/2022] Open
Abstract
In advanced inflammatory disease, microvascular thrombosis leads to the interruption of blood supply and provokes ischemic tissue injury. Recently, intravascularly adherent leukocytes have been reported to shape the blood flow in their immediate vascular environment. Whether these rheological effects are relevant for microvascular thrombogenesis remains elusive. Employing multi-channel in vivo microscopy, analyses in microfluidic devices, and computational modeling, we identified a previously unanticipated role of leukocytes for microvascular clot formation in inflamed tissue. For this purpose, neutrophils adhere at distinct sites in the microvasculature where these immune cells effectively promote thrombosis by shaping the rheological environment for platelet aggregation. In contrast to larger (lower-shear) vessels, this process in high-shear microvessels does not require fibrin generation or extracellular trap formation, but involves GPIbα-vWF and CD40-CD40L-dependent platelet interactions. Conversely, interference with these cellular interactions substantially compromises microvascular clotting. Thus, leukocytes shape the rheological environment in the inflamed venular microvasculature for platelet aggregation thereby effectively promoting the formation of blood clots. Targeting this specific crosstalk between the immune system and the hemostatic system might be instrumental for the prevention and treatment of microvascular thromboembolic pathologies, which are inaccessible to invasive revascularization strategies.
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Affiliation(s)
- Daniel Puhr-Westerheide
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Severin J Schink
- Department of Systems Biology, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthias Fabritius
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Laura Mittmann
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maximilian E T Hessenauer
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Plastic and Hand Surgery, Friedrich Alexander University Erlangen Nuernberg, Erlangen, Germany
| | - Joachim Pircher
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Cardiology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gabriele Zuchtriegel
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bernd Uhl
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Martin Holzer
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Fritz Krombach
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christoph A Reichel
- Walter Brendel Centre of Experimental Medicine, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany. .,Department of Otorhinolaryngology, Klinikum der Universität München, Ludwig-Maximilians-Universität München, Munich, Germany.
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9
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Danchin N, Popovic B, Puymirat E, Goldstein P, Belle L, Cayla G, Roubille F, Lemesle G, Ferrières J, Schiele F, Simon T. Five-year outcomes following timely primary percutaneous intervention, late primary percutaneous intervention, or a pharmaco-invasive strategy in ST-segment elevation myocardial infarction: the FAST-MI programme. Eur Heart J 2019; 41:858-866. [DOI: 10.1093/eurheartj/ehz665] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/19/2019] [Accepted: 08/30/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
ST-segment elevation myocardial infarction (STEMI) guidelines recommend primary percutaneous coronary intervention (pPCI) as the default reperfusion strategy when feasible ≤120 min of diagnostic ECG, and a pharmaco-invasive strategy otherwise. There is, however, a lack of direct evidence to support the guidelines, and in real-world situations, pPCI is often performed beyond recommended timelines. To assess 5-year outcomes according to timing of pPCI (timely vs. late) compared with a pharmaco-invasive strategy (fibrinolysis with referral to PCI centre).
Methods and results
The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) programme consists of nationwide observational surveys consecutively recruiting patients admitted for acute myocardial infarction every 5 years. Among the 4250 STEMI patients in the 2005 and 2010 cohorts, those with reperfusion therapy and onset-to-first call time <12 h (n = 2942) were included. Outcomes at 5 years were compared according to type of reperfusion strategy and timing of pPCI, using Cox multivariable analyses and propensity score matching. Among those, 1288 (54%) patients had timely pPCI (≤120 min from ECG), 830 (28%) late pPCI (>120 min), and 824 (28%) intravenous fibrinolysis. Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with late pPCI [79.5%; adjusted hazard ratio (HR) 1.51; 1.13–2.02] and similar to timely pPCI (88.2%, adjusted HR 1.02; 0.75–1.38). Concordant results were observed in propensity score-matched cohorts and for event-free survival.
Conclusion
A substantial proportion of patients have pPCI beyond recommended timelines. As foreseen by the guidelines, these patients have poorer 5-year outcomes, compared with a pharmaco-invasive strategy.
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Affiliation(s)
- Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, Rue de l'Ecole de Mèdecine, 75006 Paris, France
| | - Batric Popovic
- Department of Cardiology, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
- Université Paris Descartes, Rue de l'Ecole de Mèdecine, 75006 Paris, France
| | - Patrick Goldstein
- Department of Emergency Medicine, University Hospital of Lille, 2 avenue Oscar Lambret, 59000 Lille, France
| | - Loïc Belle
- Department of Cardiology, Centre Hospitalier Annecy Genevois, Annecy, 1 avenue de l'Hôpital, 74370, Epagny Metz-Tessy, France
| | - Guillaume Cayla
- Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Place Pr Robert Debré, 30029 Nimes Cedex 09, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, Montpellier, 191 avenue du Doyen Gaston Giraud, 34000, Montpellier, France
| | - Gilles Lemesle
- USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, 2 avenue Oscar Lambret, 59000 Lille, France
- Faculté de Médecine de l’Université de Lille, 2 avenue Eugène Avinée, 59120 Loos, France
- INSERM UMR 1011, Institut Pasteur de Lille, 1 rue Professeur Calmette, 59000 Lille, France
- FACT (French Alliance for Cardiovascular Trials), rue Henri Huchard, 75018 Paris, France
| | - Jean Ferrières
- Department of Cardiology, Toulouse University Hospital, Toulouse University School of Medicine, INSERM UMR, 1 avenue Professeur Jean Poulhès, 31059 Toulouse, Cedex 9, 1027 Toulouse, France
| | - François Schiele
- Hôpital Jean Minjoz, Université de Bourgogne-Franche-Comté, 3 boulevard Alexandre Fleming, 25000 Besançon, France
| | - Tabassome Simon
- Deparment of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST-CRB), rue de Chaligny, 75012 Paris, France
- Assistance Publique–Hôpitaux de Paris, Hôpital St Antoine, rue de Chaligny, 75012 Paris, France
- Sorbonne-Université, 91 boulevard de l'Hôpital, 75013 Paris, France
- Unité INSERM U-1148, FACT Paris, rue Henri Huchard, 75018 Paris, France
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10
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Houang EM, Bartos J, Hackel BJ, Lodge TP, Yannopoulos D, Bates FS, Metzger JM. Cardiac Muscle Membrane Stabilization in Myocardial Reperfusion Injury. JACC Basic Transl Sci 2019; 4:275-287. [PMID: 31061929 PMCID: PMC6488758 DOI: 10.1016/j.jacbts.2019.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 01/11/2019] [Accepted: 01/26/2019] [Indexed: 12/11/2022]
Abstract
The phospholipid bilayer membrane that surrounds each cell in the body represents the first and last line of defense for preserving overall cell viability. In several forms of cardiac and skeletal muscle disease, deficits in the integrity of the muscle membrane play a central role in disease pathogenesis. In Duchenne muscular dystrophy, an inherited and uniformly fatal disease of progressive muscle deterioration, muscle membrane instability is the primary cause of disease, including significant heart disease, for which there is no cure or highly effective treatment. Further, in multiple clinical forms of myocardial ischemia-reperfusion injury, the cardiac sarcolemma is damaged and this plays a key role in disease etiology. In this review, cardiac muscle membrane stability is addressed, with a focus on synthetic block copolymers as a unique chemical-based approach to stabilize damaged muscle membranes. Recent advances using clinically relevant small and large animal models of heart disease are discussed. In addition, mechanistic insights into the copolymer-muscle membrane interface, featuring atomistic, molecular, and physiological structure-function approaches are highlighted. Collectively, muscle membrane instability contributes significantly to morbidity and mortality in prominent acquired and inherited heart diseases. In this context, chemical-based muscle membrane stabilizers provide a novel therapeutic approach for a myriad of heart diseases wherein the integrity of the cardiac muscle membrane is at risk.
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Affiliation(s)
- Evelyne M. Houang
- Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jason Bartos
- Department of Medicine-Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Benjamin J. Hackel
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, Minnesota
| | - Timothy P. Lodge
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, Minnesota
- Department of Chemistry, University of Minnesota, Minneapolis, Minnesota
| | - Demetris Yannopoulos
- Department of Medicine-Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Frank S. Bates
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, Minnesota
| | - Joseph M. Metzger
- Department of Integrative Biology and Physiology, University of Minnesota Medical School, Minneapolis, Minnesota
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11
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Ben-Shoshan J, Jolicoeur EM. The Day When Coronary Stents Ruined Everything. Can J Cardiol 2018; 34:1541-1542. [PMID: 30527139 DOI: 10.1016/j.cjca.2018.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 10/29/2018] [Indexed: 11/19/2022] Open
Affiliation(s)
- Jeremy Ben-Shoshan
- Montréal Heart Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada; Tel-Aviv Medical Center, Cardiology, Tel Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - E Marc Jolicoeur
- Montréal Heart Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada.
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12
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Shrestha A, House DR, Welch JL. In Patients With ST-Segment Elevation Myocardial Infarction, Which Fibrinolytic Agent Is the Safest and Most Effective? Ann Emerg Med 2018; 72:670-671. [DOI: 10.1016/j.annemergmed.2018.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Indexed: 11/25/2022]
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13
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Ma M, Diao KY, Yang ZG, Zhu Y, Guo YK, Yang MX, Zhang Y, He Y. Clinical associations of microvascular obstruction and intramyocardial hemorrhage on cardiovascular magnetic resonance in patients with acute ST segment elevation myocardial infarction (STEMI): An observational cohort study. Medicine (Baltimore) 2018; 97:e11617. [PMID: 30045300 PMCID: PMC6078730 DOI: 10.1097/md.0000000000011617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute myocardial infarction (AMI) is recognized as being a life-threatening event. Both microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH) have been recognized as poor prognostic factors in myocardial infarct (MI) since they adversely affect left ventricular remodeling. MVO refers to small vessels changes that prevent adequate tissue perfusion despite revascularization whereas IMH is a severe form of MVO. A limited number of studies have demonstrated the segmental intervention time and the clinical factors in the presence of MVO and IMH. Therefore, we aimed in this study to determine the correlations of the intervention-associated and clinical indexes with malignant cardiovascular magnetic resonance (CMR) signs in patients with AMI.Sixty-three patients with STEMI who underwent primary percutaneous coronary intervention (PPCI) within 12 hours were included in this study. A 3.0-T CMR scan was prescribed, and the subsequent image analysis was conducted by researchers blinded to the clinical index results. Late-gadolinium enhancement (LGE) and T2* sequences were mainly used for MVO and IMH identification and quantification.Patients exhibiting both MVO and IMH had the highest level of LGE (P < .001) and were significantly more frequently assigned to a pre-PPCI thrombolysis in myocardial infarction (TIMI) flow class of 0 (n=25, 89.3%). The MVO size correlated positively with the IMH size (r = 0.81, P < .01). A pre-PPCI TIMI flow class of 0 was found to reliably predict the presence of IMH (P < .001). Patients who received the intervention 4 to 6 hours after MI onset were more likely to exhibit MVO and IMH, although this trend was not statistically significant.We showed in our study that both MVO and IMH correlated with the degree of AMI and the pre-PPCI coronary flow, and both tended to occur more frequently in cases involving an interval of 4 to 6 hours between the onset of MI and the intervention. CMR is a reliable method for assessing MVO and IMH and its imaging features following gadolinium administration are characteristic. These findings stress the importance of using CMR in evaluating and improving the outcome of the medical management.
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Affiliation(s)
- Min Ma
- Department of Cardiology, The Sixth People's Hospital of Chengdu
- Department of Cardiology
| | - Kai-yue Diao
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital
| | - Zhi-gang Yang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital
| | | | - Ying-kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Meng-xi Yang
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi Zhang
- Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital
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14
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Qiu Y, Wu Y, Meng M, Luo M, Zhao H, Sun H, Gao S. GYY4137 protects against myocardial ischemia/reperfusion injury via activation of the PHLPP-1/Akt/Nrf2 signaling pathway in diabetic mice. J Surg Res 2018; 225:29-39. [PMID: 29605032 DOI: 10.1016/j.jss.2017.12.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study explores the protective effects of a hydrogen sulfide donor, morpholin-4-ium 4-methoxyphenyl-morpholino-phosphinodithioate (GYY4137), in the hearts of diabetic mice that had been subjected to myocardial ischemia/reperfusion injury. Diabetes impairs the Akt pathway, in which the Akt protein is dephosphorylated and inactivated by PH domain leucine-rich repeat protein phosphatase-1 (PHLPP-1). However, the function of PHLPP-1 and molecular mechanism that underlies the cardiac protection exerted by GYY4137 remains unknown. METHODS Diabetic or nondiabetic mice were subjected to 45 min of coronary artery occlusion followed by 2 h of reperfusion. H9c2 cells were cultured with normal or high glucose and then subjected to 3 h of hypoxia followed by 6 h of reoxygenation. Pretreatment with GYY4137 was performed in a randomized manner before ischemia/reperfusion or hypoxia/reoxygenation. The infarct size, cardiomyocyte apoptosis, and oxidative stress were measured. Western blotting was conducted to elucidate the protective mechanism. RESULTS Diabetic mice or H9c2 cells exposed to high glucose displayed a larger infarct size, more severe cardiomyocyte apoptosis, lower cell viability, and increased oxidative stress, which were associated with increased levels of PHLPP-1 and reduced levels of p-Akt and nuclear factor-erythroid-2-related factor 2 (Nrf2) protein expression. These changes were prevented/reversed by GYYG4137 pretreatment. At the cellular level, PHLPP-1 siRNA attenuated cellular injury, and this was associated with increased p-Akt and nuclear Nrf2 protein, whereas the decrement of Akt phosphorylation induced by LY294002 augmented cellular injury and decreased nuclear Nrf2. CONCLUSIONS GYY4137 activates the PHLPP-1/Akt/Nrf2 pathway to protect against diabetic myocardial ischemia/reperfusion injury.
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Affiliation(s)
- Yun Qiu
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Yichen Wu
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Min Meng
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Man Luo
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Hongmei Zhao
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Hong Sun
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China
| | - Sumin Gao
- Department of Emergency Medicine, Huai'an First People's Hospital, Nanjing Medical University, Huai'an, Jiangsu Province, China.
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15
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Shahin M, Obeid S, Hamed L, Templin C, Gamperli O, Nietlispach F, Maier W, Yousif N, Mach F, Roffi M, Windecker S, Raber L, Matter CM, Luscher TF. Occurrence and Impact of Time Delay to Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Cardiol Res 2017; 8:190-198. [PMID: 29118880 PMCID: PMC5667705 DOI: 10.14740/cr612w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the study was to evaluate the occurrence, duration and impact of time delays to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). Methods A total of 357 consecutive STEMI patients enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. In order to identify the causes behind a possible treatment delay, we constructed four different time points which included: 1) symptom onset to hospital arrival, 2) hospital arrival to arrival in the catheterization laboratory, 3) hospital arrival to first balloon inflation, and 4) time from arrival in the catheterization laboratory to first balloon inflation in addition to total ischemic time. Patients were stratified according to a delay > 3 h, > 30 min, > 90 min and > 1 h, respectively and major adverse events at 0, 30 and 365 days were analyzed. Results Resuscitated STEMI patients (23 patients) and STEMI patients presenting at weekends (101 patients) and to lesser extent at night hours (100 patients) experienced more time delays than stable patients and those presenting at office hours. Median door-to-balloon time averaged 93 min in resuscitated, but 65 min in stable patients. Median door-to-balloon time at weekends and public holidays was 89 min, but 68 min at office hours. Median time from hospital arrival to cathlab arrival at weekends and public holidays was 30 min, but 15 min during office hours. Corresponding times for resuscitated patients was 45 and 15 min in stable patients. Of note, resuscitated patients were late presenters as regards time from symptoms onset to hospital arrival with a median time of 180 min compared to 155 min in stable patients. Median total ischemic time was 225 min for all patients, 223 min at day hours, 239 at night hours, 244 min at weekends, 233 min at office days, 220 min in stable patients and 273 min in resuscitated patients. Patients with STEMI who arrived > 3 h after symptom onset had a higher rate of myocardial infarction (MI) at 1 year (1.6% vs. 9% in < 3 h; P = 0.008). Furthermore, STEMI patients who had a delay of > 1 h from cathlab arrival to first balloon inflation had a higher rate of in hospital reinfarction at 0 day (0.6% vs. 0% in < 1 h; P = 0.007), MI at 30 days (0.8% vs. 0% in < 1 h; P = 0.001) and MI at 1 year (1.4% vs. 1.1% in < 1 h; P = 0.012). Similarly, in these patients, cardiac deaths at 0 day (0.8% vs. 0.6% in < 1 h; P = 0.035) and at 30 days (0.8% vs. 0.6% in < 1 h; P = 0.035) were higher as were major adverse cardiovascular events (MACCE) at 0 day (1.4% vs. 0.8% in < 1 h; P = 0.004). Conclusion Resuscitated STEMI patients and those presenting at weekends and to lesser extent at night hours experienced more time delays and longer ischemic time than stable patients and those presenting at office hours. In STEMI patients, any delay in treatment increased their risk of MACCE. Efforts should focus on improving patient’s awareness along with minimizing in-hospital transfer to the catheterization laboratory especially at weekends and in resuscitated patients.
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Affiliation(s)
- Mohammady Shahin
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,These authors shared first authorship
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,These authors shared first authorship
| | - Lotfy Hamed
- Department of Internal Medicine, University Hospital Sohag, Egypt
| | - Christian Templin
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Oliver Gamperli
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Willbald Maier
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Francois Mach
- Cardiovascular Center, Department of Cardiology, University Hospital Geneva, Switzerland
| | - Marco Roffi
- Cardiovascular Center, Department of Cardiology, University Hospital Geneva, Switzerland
| | - Stephan Windecker
- Cardiovascular Center, Department of Cardiology, University Hospital Bern, Switzerland
| | - Lorenz Raber
- Cardiovascular Center, Department of Cardiology, University Hospital Bern, Switzerland
| | | | - Thomas F Luscher
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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16
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Koh JQ, Tong DC, Sriamareswaran R, Yeap A, Yip B, Wu S, Perera P, Menon S, Noaman SA, Layland J. In-hospital ‘CODE STEMI’ improves door-to-balloon time in patients undergoing primary percutaneous coronary intervention. Emerg Med Australas 2017; 30:222-227. [DOI: 10.1111/1742-6723.12855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ji Quan Koh
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
| | - David C Tong
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | | | - Allysha Yeap
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Bryan Yip
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Sam Wu
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Padeepa Perera
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Shyaman Menon
- Department of Emergency; Peninsula Health; Melbourne Victoria Australia
| | - Saad Al Noaman
- Department of Emergency; Peninsula Health; Melbourne Victoria Australia
| | - Jamie Layland
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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17
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Pu J, Ding S, Ge H, Han Y, Guo J, Lin R, Su X, Zhang H, Chen L, He B. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction). Circulation 2017; 136:1462-1473. [PMID: 28844990 DOI: 10.1161/circulationaha.117.030582] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. METHODS The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay. The primary end point of the study was complete epicardial and myocardial reperfusion after PCI, defined as thrombolysis in myocardial infarction flow grade 3, thrombolysis in myocardial infarction myocardial perfusion grade 3, and ST-segment resolution ≥70%. We also measured infarct size and left ventricular ejection fraction with cardiac magnetic resonance and recorded 30-day clinical and safety outcomes. RESULTS A total of 344 patients from 7 centers were randomized to PhI (n=171) or PPCI (n=173). PhI was noninferior (and even superior) to PPCI for the primary end point (34.2% versus 22.8%, Pnoninferiority<0.05, Psuperiority=0.022), with no significant differences in the frequency of the individual components of the combined end point: thrombolysis in myocardial infarction flow 3 (91.3% versus 89.2%, P=0.580), thrombolysis in myocardial infarction myocardial perfusion grade 3 (65.8% versus 62.9%, P=0.730), and ST-segment resolution ≥70% (50.9% versus 45.5%, P=0.377). Infarct size (23.3%±11.3% versus 25.8%±13.7%, P=0.101) and left ventricular ejection fraction (52.2%±11.0% versus 51.4%±12.0%, P=0.562) were similar in both groups. No significant differences occurred in 30-day rates of total death (0.6% versus 1.2%, P=1.0), reinfarction (0.6% versus 0.6%, P=1.0), heart failure (13.5% versus 16.2%, P=0.545), major bleeding events (0.6% versus 0%, P=0.497), or intracranial hemorrhage (0% versus 0%), but minor bleeding (26.9% versus 11.0%, P<0.001) was observed more often in the PhI group. CONCLUSIONS For patients with STEMI presenting ≤6 hours after symptom onset and with an expected PCI-related delay, a PhI strategy with half-dose alteplase and timely PCI offers more complete epicardial and myocardial reperfusion when compared with PPCI. Adequately powered trials with this reperfusion strategy to assess clinical and safety outcomes are warranted. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01930682.
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Affiliation(s)
- Jun Pu
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Song Ding
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Heng Ge
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Yaling Han
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Jinchen Guo
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Rong Lin
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Xi Su
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Heng Zhang
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Lianglong Chen
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Ben He
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
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Jinatongthai P, Kongwatcharapong J, Foo CY, Phrommintikul A, Nathisuwan S, Thakkinstian A, Reid CM, Chaiyakunapruk N. Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis. Lancet 2017; 390:747-759. [PMID: 28831992 DOI: 10.1016/s0140-6736(17)31441-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fibrinolytic therapy offers an alternative to mechanical reperfusion for ST-segment elevation myocardial infarction (STEMI) in settings where health-care resources are scarce. Comprehensive evidence comparing different agents is still unavailable. In this study, we examined the effects of various fibrinolytic drugs on clinical outcomes. METHODS We did a network meta-analysis based on a systematic review of randomised controlled trials comparing fibrinolytic drugs in patients with STEMI. Several databases were searched from inception up to Feb 28, 2017. We included only randomised controlled trials that compared fibrinolytic agents as a reperfusion therapy in adult patients with STEMI, whether given alone or in combination with adjunctive antithrombotic therapy, against other fibrinolytic agents, a placebo, or no treatment. Only trials investigating agents with an approved indication of reperfusion therapy in STEMI (streptokinase, tenecteplase, alteplase, and reteplase) were included. The primary efficacy outcome was all-cause mortality within 30-35 days and the primary safety outcome was major bleeding. This study is registered with PROSPERO (CRD42016042131). FINDINGS A total of 40 eligible studies involving 128 071 patients treated with 12 different fibrinolytic regimens were assessed. Compared with accelerated infusion of alteplase with parenteral anticoagulants as background therapy, streptokinase and non-accelerated infusion of alteplase were significantly associated with an increased risk of all-cause mortality (risk ratio [RR] 1·14 [95% CI 1·05-1·24] for streptokinase plus parenteral anticoagulants; RR 1·26 [1·10-1·45] for non-accelerated alteplase plus parenteral anticoagulants). No significant difference in mortality risk was recorded between accelerated infusion of alteplase, tenecteplase, and reteplase with parenteral anticoagulants as background therapy. For major bleeding, a tenecteplase-based regimen tended to be associated with lower risk of bleeding compared with other regimens (RR 0·79 [95% CI 0·63-1·00]). The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy increased the risk of major bleeding by 1·27-8·82-times compared with accelerated infusion alteplase plus parenteral anticoagulants (RR 1·47 [95% CI 1·10-1·98] for tenecteplase plus parenteral anticoagulants plus glycoprotein inhibitors; RR 1·88 [1·24-2·86] for reteplase plus parenteral anticoagulants plus glycoprotein inhibitors). INTERPRETATION Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged. FUNDING None.
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Affiliation(s)
- Peerawat Jinatongthai
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | | | - Chee Yoong Foo
- National Clinical Research Centre, Kuala Lumpur, Malaysia; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, WI, USA; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Abstract
Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities. To administer thrombolytic therapy during transport to the catheterization laboratory could reduce time to reperfusion in cases with expected prolonged transport time to a percutaneous coronary intervention center or to a center without primary percutaneous coronary intervention capabilities with additional expected delay, known as pharmaco-invasive strategy. Myocardial reperfusion is known to produce damage and cell death, which defines the reperfusion injury. Lack of resolution of ST segment is used as a marker of reperfusion failure. In patients without ST segment resolution, mortality triples. It is important to note that, until recently, reperfusion injury and no-reflow were interpreted as a single entity and we should differentiate them as different entities; whereas no-reflow is the failure to obtain tissue flow, reperfusion injury is actually the damage produced by achieving flow. Therefore, treatment of no-reflow is obtained by tissue flow, whereas in reperfusion injury the treatment objective is protection of susceptible myocardium from reperfusion injury. Numerous trials for the treatment of reperfusion injury have been unsuccessful. Newer hypotheses such as “
controlled reperfusion”, in which the interventional cardiologist assumes not only the treatment of the culprit vessel but also the way to reperfuse the myocardium at risk, could reduce reperfusion injury.
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Affiliation(s)
- Alejandro Farah
- Interventional Cardiology Department, San Bernardo Hospital, Salta, Argentina
| | - Alejandro Barbagelata
- Universidad Católica de Buenos Aires, Buenos Aires, Argentina.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality. Int J Cardiol 2017; 245:27-34. [PMID: 28750924 DOI: 10.1016/j.ijcard.2017.07.039] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/15/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a shortage of information on regional variations in ST-segment elevation myocardial infarction (STEMI) management and prognosis at a global level. We aimed to compare patient profiles, in-hospital management and post-discharge mortality across several world regions. METHODS In total, 11,559 patients with STEMI were enrolled in two prospective studies of acute coronary syndrome survivors: EPICOR (4943 patients from 555 hospitals in 20 countries in Europe and Latin America recruited between September 2010 and March 2011) and EPICOR Asia (6616 patients from 218 hospitals in eight Asian countries recruited between June 2011 and May 2012). Comparisons were performed by eight pre-defined regions: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE), Latin America (LA), China (CN), India (IN), Southeast Asia (SA), and South Korea/Hong Kong/Singapore (KS). RESULTS Reperfusion therapy rates ranged between 53.9% (IN) and 81.2% (SE), primary percutaneous coronary intervention (PCI) between 24.8% (IN) and 65.6% (NE) and fibrinolysis between 8.1% (CN) and 34.2% (SA). Median time to primary PCI (h) ranged from 3.9 (NE) to 20.9 (IN) and to fibrinolysis from 2.4 (SE) to 6.3 (IN). Two-year mortality ranged between 2.5% in NE and 7.4% in LA. Regional variations in mortality persisted after adjustment for reperfusion therapy and known prognostic factors. CONCLUSIONS Among patients with STEMI, there is a wide regional variation in clinical profiles, hospital care and mortality. Substantial room for improvement remains at a global level for increasing reperfusion rates, reducing delays and post-discharge mortality in patients with STEMI.
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Saseendran A, Ally K, Gangadevi P, Banakar PS. Effect of supplementation of lecithin and carnitine on growth performance and nutrient digestibility in pigs fed high-fat diet. Vet World 2017; 10:149-155. [PMID: 28344396 PMCID: PMC5352838 DOI: 10.14202/vetworld.2017.149-155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022] Open
Abstract
Aim: To study the effect of dietary supplementation of lecithin and carnitine on growth performance and nutrient digestibility in pigs fed high-fat diet. Materials and Methods: A total of 30 weaned female large white Yorkshire piglets of 2 months of age were selected and randomly divided into three groups allotted to three dietary treatments, T1 - Control ration as per the National Research Council nutrient requirement, T2 - Control ration plus 5% fat, and T3 - T2 plus 0.5% lecithin plus 150 mg/kg carnitine. The total dry matter (DM) intake, fortnightly body weight of each individual animal was recorded. Digestibility trial was conducted toward the end of the experiment to determine the digestibility coefficient of various nutrients. Results: There was a significant improvement (p<0.01) observed for pigs under supplementary groups T2 and T3 than that of control group (T1) with regards to growth parameters studied such as total DM intake, average final body weight and total weight gain whereas among supplementary groups, pigs reared on T3 group had better intake (p<0.01) when compared to T2 group. Statistical analysis of data revealed that no differences were observed (p>0.05) among the three treatments on average daily gain, feed conversion efficiency, and nutrient digestibility during the overall period. Conclusion: It was concluded that the dietary inclusion of animal fat at 5% level or animal fat along with lecithin (0.5%) and carnitine (150 mg/kg) improved the growth performance in pigs than non-supplemented group and from the economic point of view, dietary incorporation of animal fat at 5% would be beneficial for improving growth in pigs without dietary modifiers.
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Affiliation(s)
- Arathy Saseendran
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - K Ally
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - P Gangadevi
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - P S Banakar
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
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Franchi F, Rollini F, Angiolillo DJ. Antithrombotic therapy for patients with STEMI undergoing primary PCI. Nat Rev Cardiol 2017; 14:361-379. [DOI: 10.1038/nrcardio.2017.18] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Emergency Department Weekend Presentation and Mortality in Patients With Acute Myocardial Infarction. Nurs Res 2017; 66:20-27. [DOI: 10.1097/nnr.0000000000000196] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Qin D, Wang X, Li Y, Yang L, Wang R, Peng J, Essandoh K, Mu X, Peng T, Han Q, Yu KJ, Fan GC. MicroRNA-223-5p and -3p Cooperatively Suppress Necroptosis in Ischemic/Reperfused Hearts. J Biol Chem 2016; 291:20247-59. [PMID: 27502281 DOI: 10.1074/jbc.m116.732735] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/06/2022] Open
Abstract
Recent studies have shown that myocardial ischemia/reperfusion (I/R)-induced necrosis can be controlled by multiple genes. In this study, we observed that both strands (5p and 3p) of miR-223 were remarkably dysregulated in mouse hearts upon I/R. Precursor miR-223 (pre-miR-223) transgenic mouse hearts exhibited better recovery of contractile performance over reperfusion period and lesser degree of myocardial necrosis than wild type hearts upon ex vivo and in vivo myocardial ischemia. Conversely, pre-miR-223 knock-out (KO) mouse hearts displayed opposite effects. Furthermore, we found that the RIP1/RIP3/MLKL necroptotic pathway and inflammatory response were suppressed in transgenic hearts, whereas they were activated in pre-miR-223 KO hearts upon I/R compared with wild type controls. Accordingly, treatment of pre-miR-223 KO mice with necrostatin-1s, a potent necroptosis inhibitor, significantly decreased I/R-triggered cardiac necroptosis, infarction size, and dysfunction. Mechanistically, we identified two critical cell death receptors, TNFR1 and DR6, as direct targets of miR-223-5p, whereas miR-223-3p directly suppressed the expression of NLRP3 and IκB kinase α, two important mediators known to be involved in I/R-induced inflammation and cell necroptosis. Our findings indicate that miR-223-5p/-3p duplex works together and cooperatively inhibits I/R-induced cardiac necroptosis at multiple layers. Thus, pre-miR-223 may constitute a new therapeutic agent for the treatment of ischemic heart disease.
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Affiliation(s)
- Dongze Qin
- From the Department of Cardiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China, Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Xiaohong Wang
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Yutian Li
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Liwang Yang
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Ruitao Wang
- Department of Intensive Care Unit, The Third Affiliated Hospital of Harbin Medical University, Heilongjiang 150081, China, and
| | - Jiangtong Peng
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Kobina Essandoh
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Xingjiang Mu
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267
| | - Tianqing Peng
- Critical Illness Research, Lawson Health Research Institute, Ontario N6A 4G5, Canada
| | - Qinghua Han
- From the Department of Cardiology, the First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Kai-Jiang Yu
- Department of Intensive Care Unit, The Third Affiliated Hospital of Harbin Medical University, Heilongjiang 150081, China, and
| | - Guo-Chang Fan
- Department of Pharmacology and Cell Biophysics, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267,
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Chen HY, Gore JM, Lapane KL, Yarzebski J, Person SD, Kiefe CI, Goldberg RJ. Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention. Clin Epidemiol 2016; 8:141-9. [PMID: 27350759 PMCID: PMC4902148 DOI: 10.2147/clep.s102225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The purpose of this study was to examine decade-long trends (2001–2011) in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI) who received a primary percutaneous coronary intervention (PCI). Methods Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629). Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED) arrival. Results The average age of this patient population was 61.9 years; 30.5% were women, and 91.7% were White. During the years under study, 50.9% of patients received a primary PCI within 90 minutes of ED arrival; this proportion increased from 2001/2003 (17.2%) to 2009/2011 (70.5%) (P<0.001). Having previously undergone coronary artery bypass graft surgery, arriving at the ED by car/walk-in and during off-hours were significantly associated with a higher risk of failing to receive a primary PCI within 90 minutes of ED arrival. Conclusion The likelihood of receiving a timely primary PCI in residents of central Massachusetts hospitalized with STEMI at the major teaching/community medical centers increased dramatically during the years under study. Several groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of failing to receive a timely primary PCI among patients acutely diagnosed with STEMI.
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Affiliation(s)
- Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sharina D Person
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA
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Defining a COPD composite safety endpoint for demonstrating efficacy in clinical trials: results from the randomized, placebo-controlled UPLIFT® trial. Respir Res 2016; 17:48. [PMID: 27141828 PMCID: PMC4855862 DOI: 10.1186/s12931-016-0361-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/19/2016] [Indexed: 12/15/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) clinical trials evaluating hard endpoints (mortality, hospitalized exacerbations) require a large number of subjects and prolonged observational periods. We hypothesized that a composite endpoint of respiratory outcomes (CERO) can help evaluate safety and benefit in COPD trials. Methods Retrospective analysis of 5992 patients enrolled in the 4-year UPLIFT® trial, a randomized trial of tiotropium versus placebo in patients with moderate-to-severe COPD. Patients were permitted to continue using their usual COPD medications except for other anticholinergics. The CERO included deaths, respiratory failure, hospitalized exacerbations, and trial dropout due to COPD worsening. The incidence rates (IRs) per 100 patient-years and risk ratios (RRs and 95 % CI) were determined at years 1 to 4. The effect of treatments on CERO was similarly assessed. A power analysis helped calculate the sample size needed to achieve outcome differences between treatments. Results The CERO IRs at years 1 to 4 for tiotropium versus placebo were 16, 13, 11, and 11, and 21, 16, 14, and 13, respectively. The RRs of CERO between tiotropium and placebo at the same time points were: RR-year 0.76 (0.67, 0.86), 0.80 (0.72, 0.88), 0.81 (0.74, 0.89), and 0.84 (0.77, 0.92). Using the IRs and RRs, the sample size (alpha = 0.05 two-sided, 90 % power) for studies of 1, 2, 3, and 4 years would be 1546, 1392, 1216, and 1504 per treatment group, respectively, with 575, 810, 930, 1383 required events, respectively, for hypothetical, event-driven studies. Conclusions A composite endpoint incorporating relatively infrequent serious or significant COPD-related safety outcomes could be useful in clinical trials. In UPLIFT®, CERO events were significantly reduced in patients receiving tiotropium compared with placebo. Trial registration NCT00144339. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0361-4) contains supplementary material, which is available to authorized users.
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Li J, Li X, Ross JS, Wang Q, Wang Y, Desai NR, Xu X, Nuti SV, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:232-243. [PMID: 26787648 DOI: 10.1177/2048872615626656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention. METHODS Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention. RESULTS We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( Ptrend=0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients. CONCLUSIONS Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.
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Affiliation(s)
- Jing Li
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Xi Li
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Joseph S Ross
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,3 Section of General Internal Medicine, Yale School of Medicine, USA.,4 The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA.,5 Department of Health Policy and Management, Yale School of Public Health, USA
| | - Qing Wang
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Yongfei Wang
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Nihar R Desai
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Xiao Xu
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,7 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, USA
| | - Sudhakar V Nuti
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA
| | - Frederick A Masoudi
- 8 Division of Cardiology, University of Colorado Anschutz Medical Campus, USA
| | - John A Spertus
- 9 Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, USA
| | - Harlan M Krumholz
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,4 The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA.,5 Department of Health Policy and Management, Yale School of Public Health, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Lixin Jiang
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
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Buja L, Schoen F. The Pathology of Cardiovascular Interventions and Devices for Coronary Artery Disease, Vascular Disease, Heart Failure, and Arrhythmias. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00032-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Hagen TP, Häkkinen U, Iversen T, Klitkou ST, Moger TA. Socio-economic Inequality in the Use of Procedures and Mortality Among AMI Patients: Quantifying the Effects Along Different Paths. HEALTH ECONOMICS 2015; 24 Suppl 2:102-115. [PMID: 26633871 DOI: 10.1002/hec.3269] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/02/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
It is not known whether inequality in access to cardiac procedures translates into inequality in mortality. In this paper, we use a path analysis model to quantify both the direct effect of socio-economic status on mortality and the indirect effect of socio-economic status on mortality as mediated by the provision of cardiac procedures. The study links microdata from the Finnish and Norwegian national patient registers describing treatment episodes with data from prescription registers, causes-of-death registers and registers covering education and income. We show that socio-economic variables affect access to percutaneous coronary intervention in both countries, but that these effects are only moderate and that the indirect effects of the socio-economic factors on mortality through access to percutaneous coronary intervention are minor. The direct effects of income and education on mortality are significantly larger. We conclude that the socio-economic gradient in the use of percutaneous coronary intervention adds to socio-economic differences in mortality to little or no extent.
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Affiliation(s)
- Terje P Hagen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Unto Häkkinen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
- Centre for Health and Social Economics (CHESS), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Søren Toksvig Klitkou
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS guidelines on myocardial revascularization. EUROINTERVENTION 2015; 10:1024-94. [PMID: 25187201 DOI: 10.4244/eijy14m09_01] [Citation(s) in RCA: 211] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stephan Windecker
- Cardiology, Bern University Hospital, Freiburgstrasse 4, CH-3010 Bern, Switzerland
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Dan H, Zhang L, Qin X, Peng X, Wong M, Tan X, Yu S, Fang N. Moutan cortex extract exerts protective effects in a rat model of cardiac ischemia/reperfusion. Can J Physiol Pharmacol 2015; 94:245-50. [PMID: 26610043 DOI: 10.1139/cjpp-2015-0168] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Moutan cortex (MC) is a traditional Chinese medicine with diverse biological effects. The present study was performed to investigate the effects of MC on myocardial ischemia/reperfusion (I/R) in rats and to explore its possible mechanisms. Sprague-Dawley rats were administered MC extract (1.98 g/kg, i.g.) for 14 days and underwent a subsequent open-chest procedure involving 30 min of myocardial ischemia and 60 min of reperfusion. The cardioprotective effect of MC was demonstrated by reduced infarct size and marked improvement in the histopathological examination. The increase in the activity of superoxide dismutase (SOD) and glutathione (GSH) as well as the reduction of malondialdehyde (MDA) indicated that MC effectively promoted the anti-oxidative defense system. Increased anti-oxidative defense was accompanied by decreased release of lactate dehydrogenase (LDH) and creatine kinase (CK). The reduction in TUNEL-positive myocytes demonstrated that MC decreased myocardial apoptosis. The mRNA expression of B cell leukemia-2 (Bcl-2) was upregulated by MC and the ratio of Bcl-2/Bcl-2-associated X protein (Bax) mRNA expression was increased. MC pretreatment decreased the mRNA expression of inducible nitric oxide synthase (iNOS). The data from this study suggest that MC exerted protective effects on acute myocardial I/R injury via anti-oxidative and anti-apoptotic activities.
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Affiliation(s)
- Hong Dan
- a Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, 1 Huang-jia-hu, Wuhan, China
| | - Liping Zhang
- a Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, 1 Huang-jia-hu, Wuhan, China
| | - Xiaolin Qin
- a Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, 1 Huang-jia-hu, Wuhan, China
| | - Xiaohui Peng
- a Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, 1 Huang-jia-hu, Wuhan, China
| | - Mingyan Wong
- a Key Laboratory of Chinese Medicine Resource and Compound Prescription (Hubei University of Chinese Medicine), Ministry of Education, 1 Huang-jia-hu, Wuhan, China
| | - Xuan Tan
- b Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, China
| | - Shanggong Yu
- c Arkansas Children's Nutrition Center, Little Rock, AR 72202, USA
| | - Nianbai Fang
- c Arkansas Children's Nutrition Center, Little Rock, AR 72202, USA.,d Departments of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Thylén I, Ericsson M, Hellström Ängerud K, Isaksson RM, Sederholm Lawesson S. First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open 2015; 5:e007059. [PMID: 25900460 PMCID: PMC4410112 DOI: 10.1136/bmjopen-2014-007059] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients' FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis. SETTING Multicentred study, Sweden. METHODS Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission. RESULTS We included 109 women and 336 men (mean age 66±11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1:59 vs 1:21 h, p<0.001). CONCLUSIONS Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.
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Affiliation(s)
- Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Ericsson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Karin Hellström Ängerud
- Department of Cardiology, Heart Centre and Department of Nursing, Umeå University, Umeå, Sweden
| | - Rose-Marie Isaksson
- Department of Research, Norrbotten County Council, Luleå, Sweden
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 Update on Percutaneous Coronary Intervention Without On-Site Surgical Backup. Catheter Cardiovasc Interv 2015; 84:169-87. [PMID: 25045090 DOI: 10.1002/ccd.25371] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 12/21/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Gregory J Dehmer
- Baylor Scott & White Health, Central Texas, Temple, TX. SCAI Writing Committee Member and Chair
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Laufer-Perl M, Shacham Y, Letourneau-Shesaf S, Priesler O, Keren G, Roth A, Steinvil A. Gender-related mortality and in-hospital complications following ST-segment elevation myocardial infarction: data from a primary percutaneous coronary intervention cohort. Clin Cardiol 2015; 38:145-9. [PMID: 25728563 DOI: 10.1002/clc.22363] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/28/2014] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The increased mortality related to female gender in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) has been reported from various patient cohorts and treatment strategies with controversial results. In the present work, we evaluated the impact of female gender on mortality and in-hospital complications among a specific subset of consecutive STEMI patients managed solely by PPCI. HYPOTHESIS Female gender is not an independent predicor for mortality among STEMI patients. METHODS We performed a retrospective, single-center observational study that included 1346 consecutive STEMI patients undergoing PPCI, of which 1075 (80%) were male. Patient's records were evaluated for 30-day mortality, in-hospital complications, and long-term mortality over a mean period of 2.7 ± 1.6 years. RESULTS Compared with males, females were older (69 ± 13 vs 60 ± 13 years, P < 0.001), had a significantly higher rate of baseline risk factors, and had prolonged symptom duration (460 ± 815 minutes vs 367 ± 596 minutes, P = 0.03). Females suffered from more in-hospital complications and had higher 30-day mortality (5% vs 2%, P = 0.008) as well as higher overall mortality (12.5% vs 6%, P < 0.001). In spite of the significant mortality risk in unadjusted models, a multivariate adjusted Cox regression model did not demonstrate that female gender was an independent predictor for mortality among STEMI patients. CONCLUSIONS Among patients with STEMI treated by PPCI, female gender is associated with a higher 30-day mortality and complications rates compared to males. Following multivariate analysis, female gender was not a significant predictor of long-term death following STEMI.
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Affiliation(s)
- Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Li J, Li X, Wang Q, Hu S, Wang Y, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. ST-segment elevation myocardial infarction in China from 2001 to 2011 (the China PEACE-Retrospective Acute Myocardial Infarction Study): a retrospective analysis of hospital data. Lancet 2015; 385:441-51. [PMID: 24969506 PMCID: PMC4415374 DOI: 10.1016/s0140-6736(14)60921-1] [Citation(s) in RCA: 318] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Despite the importance of ST-segment elevation myocardial infarction (STEMI) in China, no nationally representative studies have characterised the clinical profiles, management, and outcomes of this cardiac event during the past decade. We aimed to assess trends in characteristics, treatment, and outcomes for patients with STEMI in China between 2001 and 2011. METHODS In a retrospective analysis of hospital records, we used a two-stage random sampling design to create a nationally representative sample of patients in China admitted to hospital for STEMI in 3 years (2001, 2006, and 2011). In the first stage, we used a simple random-sampling procedure stratified by economic-geographical region to generate a list of participating hospitals. In the second stage we obtained case data for rates of STEMI, treatments, and baseline characteristics from patients attending each sampled hospital with a systematic sampling approach. We weighted our findings to estimate nationally representative rates and assess changes from 2001 to 2011. This study is registered with ClinicalTrials.gov, number NCT01624883. FINDINGS We sampled 175 hospitals (162 participated in the study) and 18,631 acute myocardial infarction admissions, of which 13,815 were STEMI admissions. 12,264 patients were included in analysis of treatments, procedures, and tests, and 11,986 were included in analysis of in-hospital outcomes. Between 2001 and 2011, estimated national rates of hospital admission for STEMI per 100,000 people increased (from 3·5 in 2001, to 7·9 in 2006, to 15·4 in 2011; ptrend<0·0001) and the prevalence of risk factors-including smoking, hypertension, diabetes, and dyslipidaemia-increased. We noted significant increases in use of aspirin within 24 h (79·7% [95% CI 77·9-81·5] in 2001 vs 91·2% [90·5-91·8] in 2011, ptrend<0·0001) and clopidogrel (1·5% [95% CI 1·0-2·1] in 2001 vs 82·1% [81·1-83·0] in 2011, ptrend<0·0001) in patients without documented contraindications. Despite an increase in the use of primary percutaneous coronary intervention (10·6% [95% CI 8·6-12·6] in 2001 vs 28·1% [26·6-29·7] in 2011, ptrend<0·0001), the proportion of patients who did not receive reperfusion did not significantly change (45·3% [95% CI 42·1-48·5] in 2001 vs 44·8% [43·1-46·5] in 2011, ptrend=0·69). The median length of hospital stay decreased from 12 days (IQR 7-18) in 2001 to 10 days (6-14) in 2011 (ptrend<0·0001). Adjusted in-hospital mortality did not significantly change between 2001 and 2011 (odds ratio 0·82, 95% CI 0·62-1·10, ptrend=0·07). INTERPRETATION During the past decade in China, hospital admissions for STEMI have risen; in these patients, comorbidities and the intensity of testing and treatment have increased. Quality of care has improved for some treatments, but important gaps persist and in-hospital mortality has not decreased. National efforts are needed to improve the care and outcomes for patients with STEMI in China. FUNDING National Health and Family Planning Commission of China.
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Affiliation(s)
- Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Wang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuang Hu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Symons R, Masci PG, Goetschalckx K, Doulaptsis K, Janssens S, Bogaert J. Effect of Infarct Severity on Regional and Global Left Ventricular Remodeling in Patients with Successfully Reperfused ST Segment Elevation Myocardial Infarction. Radiology 2015; 274:93-102. [DOI: 10.1148/radiol.14132746] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3326] [Impact Index Per Article: 332.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Brogan RA, Malkin CJ, Batin PD, Simms AD, McLenachan JM, Gale CP. Risk stratification for ST segment elevation myocardial infarction in the era of primary percutaneous coronary intervention. World J Cardiol 2014; 6:865-873. [PMID: 25228966 PMCID: PMC4163716 DOI: 10.4330/wjc.v6.i8.865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/30/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Acute coronary syndromes presenting with ST elevation are usually treated with emergency reperfusion/revascularisation therapy. In contrast current evidence and national guidelines recommend risk stratification for non ST segment elevation myocardial infarction (NSTEMI) with the decision on revascularisation dependent on perceived clinical risk. Risk stratification for STEMI has no recommendation. Statistical risk scoring techniques in NSTEMI have been demonstrated to improve outcomes however their uptake has been poor perhaps due to questions over their discrimination and concern for application to individuals who may not have been adequately represented in clinical trials. STEMI is perceived to carry sufficient risk to warrant emergency coronary intervention [by primary percutaneous coronary intervention (PPCI)] even if this results in a delay to reperfusion with immediate thrombolysis. Immediate thrombolysis may be as effective in patients presenting early, or at low risk, but physicians are poor at assessing clinical and procedural risks and currently are not required to consider this. Inadequate data on risk stratification in STEMI inhibits the option of immediate fibrinolysis, which may be cost-effective. Currently the mode of reperfusion for STEMI defaults to emergency angiography and percutaneous coronary intervention ignoring alternative strategies. This review article examines the current risk scores and evidence base for risk stratification for STEMI patients. The requirements for an ideal STEMI risk score are discussed.
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Dehmer GJ, Blankenship JC, Cilingiroglu M, Dwyer JG, Feldman DN, Gardner TJ, Grines CL, Singh M. SCAI/ACC/AHA Expert Consensus Document: 2014 update on percutaneous coronary intervention without on-site surgical backup. J Am Coll Cardiol 2014; 63:2624-2641. [PMID: 24651052 DOI: 10.1016/j.jacc.2014.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Affiliation(s)
- Stefan K James
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center, Uppsala University Hospita, 751 85 Uppsala, Sweden.
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