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XU N, ZHANG C, JIANG L, XU JJ, LIU R, SONG Y, ZHAO XY, XU LJ, GAO RL, XU B, YUAN JQ, SONG L. Long-term outcome of percutaneous or surgical revascularization with and without prior stroke in patients with three-vessel disease. J Geriatr Cardiol 2022; 19:583-593. [PMID: 36339466 PMCID: PMC9629998 DOI: 10.11909/j.issn.1671-5411.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVE To determine whether high-risk patients with three-vessel disease (TVD) with and without prior stroke preferentially benefit from three strategies [percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical therapy (MT)]. METHODS A total of 8943 patients with TVD were included in the study. Patients enrolled were stratified into two categories according to the presence or absence of prior stroke history. The primary endpoint was all-cause death. Secondary endpoints included stroke and major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction (MI), unplanned revascularization and stroke. RESULTS Prior stroke was present in 888 patients (9.9%). These patients were older and had higher rates of comorbidities. During a median follow-up of 7.5 years, patients with prior stroke were strongly associated with increased risks of all-cause death, cardiac death, stroke and MACCE, even after adjusting for confounding variables and results been consistent across either treatment subgroup (PCI, CABG and MT) (all adjusted P < 0.01). Notably, there was a significant interaction between prior stroke history and treatment strategies. Revascularization strategy (PCI or CABG) was associated with a lower incidence of all-cause death and MACCE compared with MT alone, and favorable rates of MACCE, MI and unplanned revascularization in the CABG group compared with the PCI group, but with similar rate of all-cause death regardless of prior stroke history. The prevalence of stroke was significantly higher after CABG when compared with PCI or MT in no prior stroke patients [hazard ratio (HR) = 1.429, 95% CI: 1.132-1.805 for CABG vs. MT; HR = 1.703, 95% CI: 1.371-2.116 for CABG vs. PCI]. CONCLUSIONS Patients with TVD and prior stroke have poor clinical outcomes. It is essential to balance benefit and risk when determining the optimal treatment strategy for TVD with and without prior stroke.
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Affiliation(s)
- Na XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ce ZHANG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin JIANG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Jing XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ru LIU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying SONG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xue-Yan ZHAO
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lian-Jun XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Run-Lin GAO
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo XU
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jin-Qing YUAN
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei SONG
- Center for Coronary Heart Disease, National Clinical Research Center for Cardiovascular Diseases, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Hu X, Fu S, Wang S. Hyperuricemia is associated with an increased prevalence of ventricular tachycardia and fibrillation in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:199. [PMID: 35473480 PMCID: PMC9044610 DOI: 10.1186/s12872-022-02635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the association between hyperuricemia and ventricular tachycardia and fibrillation (VT/VF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods The data from a cohort of STEMI patients undergoing PPCI at our center from January 2013 to December 2018 were retrospectively analyzed. The endpoint of the study was the occurrence of VT/VF, including (1) non-sustained ventricular tachycardia (nsVT) on Holter monitoring; (2) sustained ventricular tachycardia (SVT)/VF on cardiac monitoring. Results Of the 634 patients included in the study, 147 (23.2%) of them had hyperuricemia. The occurrence of VT/VF after PPCI was significantly higher in patients with hyperuricemia (19.0 vs. 9.4%, p = 0.001) compared with those without hyperuricemia. Hyperuricemia was associated with a significantly higher risk of VF/VT (odds ratio (OR) 2.11; 95% CI 1.11–4.03; p = 0.024). The strength of this association remained statistically after adjustments for age, sex, history of hypertension, estimated glomerular filtration rate, hypersensitive C reactive protein, plasma natrium, peak troponin I, fasting glucose, B-type natriuretic peptides and VT/VF in PPCI (adjusted odds ratio 2.73; 95% CI 1.19–6.27; p = 0.018). Conclusions There is a significant association between hyperuricemia and increased prevalence of VT/VF in STEMI patients after PPCI, independently of multiple risk factors and potential confounders. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02635-4.
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Affiliation(s)
- Xianqing Hu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China.
| | - Shenwen Fu
- Department of Cardiovascular Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, No. 365, East Renmin Road, Jinhua, 321000, Zhejiang Province, China
| | - Saibin Wang
- Department of Respiratory Medicine, Jinhua Municipal Central Hospital, Jinhua Hospital of Zhejiang University, Jinhua, Zhejiang Province, China
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Wang W, Zheng H. Myocardial Infarction: The Protective Role of MiRNAs in Myocardium Pathology. Front Cardiovasc Med 2021; 8:631817. [PMID: 33748196 PMCID: PMC7973051 DOI: 10.3389/fcvm.2021.631817] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases have been regarded as the leading cause of death around the world, with myocardial infarction (MI) being the most severe form. MI leads to myocardial apoptosis, cardiomyocyte fibrosis, and cardiomyocyte hypertrophy, ultimately leading to heart failure, and death. Micro RNAs (miRNAs) participate in the genesis and progression of myocardial pathology after MI by playing an important regulatory role. This review aims to summarize all available knowledge on the role of miRNAs in the myocardial pathological process after MI to uncover potential major target pathways. In addition, the main therapeutic methods and their latest progress are also reviewed. miRNAs can regulate the main signaling pathways as well as pathological processes. Thus, they have the potential to induce therapeutic effects. Hence, the combination of miRNAs with recently developed exosome nanocomplexes may represent the future direction of therapeutics.
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Affiliation(s)
- Wei Wang
- Graduate School of Bengbu Medical College, Bengbu, China
| | - Hao Zheng
- Department of Cardiovascular Medicine, Zhejiang Provincial People's Hospital, Hangzhou, China
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Luo R, Sun X, Shen F, Hong B, Wang Z. Effects of High-Dose Rosuvastatin on Ventricular Remodelling and Cardiac Function in ST-Segment Elevation Myocardial Infarction. Drug Des Devel Ther 2020; 14:3891-3898. [PMID: 33061295 PMCID: PMC7520152 DOI: 10.2147/dddt.s254948] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/05/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To investigate the effects of high-dose rosuvastatin on ventricular remodelling and cardiac function in ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS From January 2017 to March 2019, the clinical data of 93 patients with STEMI were collected and analysed, with 46 cases in the conventional-dose group (rosuvastatin, 10 mg/d) and 47 cases in the high-dose group (rosuvastatin, 20 mg/d). Blood lipid (TC, TG, LDL-C and HDL-C), serum inflammatory markers (hs-CRP, IL-6, TNF-α and ICAM-1), ventricular remodelling markers (NT-pro BNP, MMP-9, TIMP-4 and Gal-3) and indicators of cardiac function (LVESD, LVESD, LVESV, LVEDV, IVST and LVEF) were collected from all patients at the time of admission and 8 weeks after rosuvastatin treatment. RESULTS After treatment with rosuvastatin for 8 weeks, compared with those in conventional-dose group, the levels of TC, TG, LDL-C, hs-CRP, IL-6, TNF-α, ICAM-1, NT-pro BNP, MMP-9 and Gal-3 in the high-dose group decreased significantly (P<0.05), while the increase of HDL-C and TIMP-4 levels was more obvious (P<0.05) than that in the conventional-dose group. Moreover, LVEF was significantly higher (P<0.05) and LVESD, LVESD, LVESV, LVEDV and IVST were significantly lower (P< 0.05) after treatment than before treatment in both groups. The improvement of cardiac ultrasound results in the high-dose group was more significant than that in the conventional-dose group (P< 0.05). CONCLUSION This study suggests that high-dose rosuvastatin was better than conventional-dose rosuvastatin for improving blood lipid metabolism, reducing the inflammatory response, and preventing and treating ventricular remodelling and myocardial fibrosis, indicating that high-dose rosuvastatin had stronger therapeutic effect on STEMI than conventional-dose rosuvastatin.
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Affiliation(s)
- Rong Luo
- Department of Cardiology, Qingpu Medical Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaochen Sun
- Department of Cardiology, Qingpu Medical Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Feiyan Shen
- Department of Cardiology, Qingpu Medical Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Bin Hong
- Department of Cardiology, Qingpu Medical Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zilong Wang
- Department of Cardiology, Qingpu Medical Center, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
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Teng RL, Wang H, Sun BC, Cai DP, He YM. Interaction between lipoprotein (a) levels and body mass index in first incident acute myocardial infarction. BMC Cardiovasc Disord 2020; 20:350. [PMID: 32723301 PMCID: PMC7389650 DOI: 10.1186/s12872-020-01626-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Possible interaction between Lipoprotein (a) (Lp(a)) and body mass index (BMI) was investigated with regard to the risk of first incident acute myocardial infarction (AMI). METHODS Cross-sectional study of 1522 cases with initial AMI and 1691 controls without coronary artery disease (CAD) were retrospectively analyzed using logistic regression model. Subjects were categorized based on Lp(a) and BMI and compared with regard to occurrence of AMI by calculating odds ratios (ORs) with 95% confidence intervals (CIs). A potential interaction between Lp(a) and BMI was evaluated by the measures of effect modification on both additive (Relative excess risk due to interaction, RERI) and multiplicative scales. RESULTS Compared with reference group (BMI < 24 kg/m2 and in the first quintile of Lp(a)), multivariable-adjusted analysis revealed that ORs(95%CI) of AMI were 2.27(1.46-3.52) for higher BMI alone; 1.79(1.11-2.90), 1.65(1.05-2.60), 1.96(1.20-3.20) and 2.34(1.47-3.71) for higher Lp(a) alone across its quintiles; and 2.86(1.85-4.40), 3.30(2.14-5.11), 4.43(2.76-7.09) and 5.98(3.72-9.60) for both higher BMI and higher Lp(a), greater than the sum of the both risks each. Prominent interaction was found between Lp(a) and BMI on additive scale (RERI = 2.45 (0.36-4.54) at the fifth quintile of Lp(a)) but not on multiplicative scale. CONCLUSIONS This study demonstrates that BMI and Lp(a) levels are important factors affecting the risk of AMI. Significant interaction is found between Lp(a) and BMI in initial AMI on additive scale, indicating that Lp(a) confers greater risk for initial AMI when BMI is elevated. For those whose BMIs are inadequately controlled, Lp(a) lowering may be an option. TRIAL REGISTRATION This clinical study was not registered in a publicly available registry because this study was a retrospective study first started in 2015. Data are available via the correspondent.
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Affiliation(s)
- Ruo-Ling Teng
- Division of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P.R. China
| | - Heng Wang
- Division of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P.R. China
| | - Bei-Chen Sun
- Division of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P.R. China
| | - Dong-Ping Cai
- Healthcare Center for Shishan Street Community of Suzhou New District, Suzhou, Jiangsu Province, 215011, P.R. China
| | - Yong-Ming He
- Division of Cardiology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, P.R. China.
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Torralba F, Navarro A, la Hoz JCD, Ortiz C, Botero A, Alarcón F, Isaza N, Isaza D. HEART, TIMI, and GRACE Scores for Prediction of 30-Day Major Adverse Cardiovascular Events in the Era of High-Sensitivity Troponin. Arq Bras Cardiol 2020; 114:795-802. [PMID: 32187284 PMCID: PMC8387004 DOI: 10.36660/abc.20190206] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/17/2019] [Indexed: 11/23/2022] Open
Abstract
Fundamento Múltiplos sistemas de pontuação têm sido elaborados para calcular o risco de eventos cardiovasculares adversos maiores (MACE) em pacientes com dor no peito. Não há dados que avaliem se o escore HEART tem um desempenho superior a TIMI e GRACE para a predição de MACE, especialmente na era de troponina I de alta sensibilidade e em uma população exclusivamente latino-americana. Objetivo Comparar o desempenho dos escores HEART, TIMI e GRACE para a predição de MACE em 30 dias de acompanhamento, em pacientes atendidos com dor no peito no departamento de emergência. Métodos Os escores HEART, TIMI e GRACE foram analisados em 519 pacientes com dor no peito no departamento de emergência. O desfecho primário foi a ocorrência de MACE no período de 30 dias. O desempenho do escore HEART foi comparado com o dos escores TIMI e GRACE utilizando o teste de DeLong, considerando estatisticamente significativos os valores de p de 0,05. Resultados Um total de 224 pacientes (43%) apresentaram MACE no período de 30 dias. A estatística C para os escores HEART, TIMI e GRACE foi de 0,937, 0,844 e 0,797 respectivamente (p < 0,0001). Uma pontuação de 3 ou menos no escore HEART apresentou uma sensibilidade de 99,5% e um valor preditivo negativo de 99% para classificar pacientes de baixo risco de maneira correta; ambos os valores foram mais elevados do que aqueles obtidos pelos outros escores. Conclusão O escore HEART, em um período de 30 dias, prediz eventos cardiovasculares, mais eficazmente, em comparação com os outros escores. Troponinas de alta sensibilidade mantêm a superioridade previamente demonstrada deste escore. Este escore oferece uma identificação mais precisa dos pacientes de baixo risco. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)
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Affiliation(s)
- Felipe Torralba
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | - Alberto Navarro
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | | | - Carlos Ortiz
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | - Alberth Botero
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | - Freddy Alarcón
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | - Nicolas Isaza
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
| | - Daniel Isaza
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota Cundinamarca - Colômbia
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Association between TGF-β1 -913G/C polymorphism and myocardial infarction risk in a Chinese Han population: a case-control study. Biosci Rep 2019; 39:BSR20190315. [PMID: 31147455 PMCID: PMC6617046 DOI: 10.1042/bsr20190315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 05/15/2019] [Accepted: 05/28/2019] [Indexed: 12/22/2022] Open
Abstract
Transforming growth factor (TGF)-β1 contributed to angiotensin II (Ang II)-mediated collagen accumulation after myocardial infarction (MI). The present study aimed to investigate the association of genetic variant of TGF-β1 gene with the risk of MI. The present study recruited a total of 530 MI patients and 651 healthy controls. The genomic DNA was extracted and subjected into polymerase chain reaction (PCR) and Sanger sequencing. The present study indicated that TGF-β1 -913G/C polymorphism was associated with increased risk for MI under the co-dominant, dominant and allelic models. The increased risk effect was also evident among the females, younger subjects (age < 60 years), smokers, non-drinkers and individuals with hypertension. Additionally, the present study observed significant differences among cases and controls in terms of total cholesterol (TC). In conclusion, TGF-β1 -913G/C polymorphism is associated with increased risk for MI. TGF-β1 -913G/C polymorphism may be a potential prognostic biomarker for MI.
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Mao S, Taylor S, Chen Q, Zhang M, Hinek A. Sodium tanshinone IIA sulfonate prevents the adverse left ventricular remodelling: Focus on polymorphonuclear neutrophil-derived granule components. J Cell Mol Med 2019; 23:4592-4600. [PMID: 31066232 PMCID: PMC6584480 DOI: 10.1111/jcmm.14306] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022] Open
Abstract
AIMS The aims of this study were to evaluate the effects of sodium tanshinone IIA sulfonate (STS) on left ventricular (LV) remodelling after for ST-elevated myocardial infarction (STEMI). METHODS AND RESULTS In this prospective, randomized clinical trial, 101 patients with the ST-elevated MI (STEMI) and a successful reperfusion were immediately randomized to receive STS (80 mg qd for 7 days) or saline control, along with standard therapy. The primary effectiveness endpoint is the % change in LV end diastolic volumes index (%∆ LVEDVi) as measured by echocardiography from baseline to 6 months. Secondary effectiveness endpoints include 6-month period for major adverse cardiac events (MACE), including the occurrence of recurrent myocardial infarction, death, hospitalization for heart failure and malignant arrhythmia. The 6-month changes in %∆ LVEDVi were significantly smaller in the STS group than in the control group [-5.05% vs 3.32%; P < 0.001]. With respect to MACE, there was a significant difference between those who received STS (8.16%) and those patients on control (26.00%) (P = 0.019). Meaningfully, results of parallel tests aimed at mechanistic explanation of the reported clinical effects, revealed a significantly reduced levels of neutrophils-derived granule components in the blood of STS treated patients. CONCLUSION We found that short-term treatment with STS reduced progressive left ventricular remodelling and subsequent better clinical outcome that could be mechanistically linked to the inhibition of the ultimate damage of infarcted myocardium by infiltrating neutrophils.
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Affiliation(s)
- Shuai Mao
- Key Discipline of Integrated Chinese and Western Medicine, Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Shalina Taylor
- Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Qubo Chen
- Biological Resource Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Minzhou Zhang
- Key Discipline of Integrated Chinese and Western Medicine, Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Aleksander Hinek
- Translational Medicine, Hospital for Sick Children, Toronto, Canada
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Effects of Ticagrelor versus Clopidogrel in Patients with Coronary Bifurcation Lesions Undergoing Percutaneous Coronary Intervention. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3170957. [PMID: 31016189 PMCID: PMC6448338 DOI: 10.1155/2019/3170957] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/20/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
Background Percutaneous treatment of coronary bifurcation lesions can potentially lead to higher risk of ischemic events than the nonbifurcation ones, thus calling for further optimization of dual antiplatelet therapy (DAPT). This study aimed to compare the clinical outcomes from ticagrelor and clopidogrel in bifurcation lesions patients undergoing percutaneous coronary intervention (PCI). Methods We performed a retrospective cohort study in patients with coronary bifurcation lesions. A total of 553 patients discharged on ticagrelor or clopidogrel combined with aspirin were recruited for 1-year follow-up. The incidences of primary endpoint (major adverse cardiovascular event [MACE]: a composite of cardiac death, myocardial infarction [MI] or stroke), secondary endpoints (the individual component of the primary endpoint or definite/probable stent thrombosis), and major bleeding (Bleeding Academic Research Consortium [BARC]≥3 bleeding events) were evaluated. To minimize the selection bias, a propensity score-matched population analysis was also conducted. Results The risks of both primary endpoint (8.15% and 12.01% for the ticagrelor and clopidogrel groups, respectively; adjusted hazards ratio [HR]: 0.488, 95% confidence interval [CI]: 0.277-0.861, P=0.013) and MI (4.44% and 8.48% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.341, 95% CI: 0.162-0.719, P=0.005) were significantly reduced in the ticagrelor group as compared with those of the clopidogrel counterpart, whereas the risk of major bleeding was comparable (2.96% and 2.47% for the ticagrelor and clopidogrel groups, respectively; adjusted HR: 0.972, 95% CI: 0.321-2.941, P=0.960). Propensity score-matched analysis confirmed such findings. Conclusions For patients with bifurcation lesions after PCI, ticagrelor treatment shows lower MACE and MI rates than the clopidogrel one, along with comparable major bleeding.
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Negahdary M, Behjati-Ardakani M, Sattarahmady N, Heli H. An Aptamer-based Biosensor for Troponin I Detection in Diagnosis of Myocardial Infarction. J Biomed Phys Eng 2018; 8:167-178. [PMID: 29951443 DOI: 10.31661/jbpe.v8i2.930] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 05/15/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Acute myocardial infarction (MI) accounts for one third of deaths. Cardiac troponin I (TnI) is a reliable biomarker of cardiac muscle tissue injury and is employed in the early diagnosis of MI. OBJECTIVE In this study, a molecular method is introduced to early diagnosis of MI by rapid detection of TnI. MATERIALS AND METHODS The detection method was based on electrochemical aptasensing, being developed using different methods and evaluation steps. A gold electrode was used as a transducer to successful immobilize 76base aptamer to fabricate a TnI biosensor. RESULTS The designed aptasensor could detect TnI in a range of 0.03 to 2.0 ng mL-1 without using any label, pre-concentration or amplification steps. The limit of detection was attained as 10 pg mL-1 without significant trouble of interfering species. The TnI biosensor demonestrated a stable, regenerative and reproducible function. 89 human samples were used to evaluate the performance of the TnI biosensor, and it represented 100% and 81%, diagnostic sensitivity and specificity, respectively. CONCLUSION This aptasensor may be used as an applicable tool in the future of early medical diagnosis of MI.
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Affiliation(s)
- M Negahdary
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Behjati-Ardakani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - N Sattarahmady
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Medical Physics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H Heli
- Nanomedicine and Nanobiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Parahuleva MS, Euler G, Mardini A, Parviz B, Schieffer B, Schulz R, Aslam M. Identification of microRNAs as potential cellular monocytic biomarkers in the early phase of myocardial infarction: a pilot study. Sci Rep 2017; 7:15974. [PMID: 29162889 PMCID: PMC5698316 DOI: 10.1038/s41598-017-16263-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
MicroRNA has been increasingly suggested to be involved in vascular inflammation. The aim of this study was to assess the expression profile of miRs as possible novel cellular biomarkers in circulating monocytes in patients with ST-segment elevation myocardial infarction (STEMI). Microarray techniques and TaqMan polymerase chain reaction were used to analyse the global expression of 352 miRNAs in peripheral blood monocytes from healthy donors (n = 20) and patients (n = 24) with acute STEMI. The expression level of miR-143 in monocytes from STEMI patients compared to healthy controls was increased, whereas the expression of miR-1, -92a, -99a, and -223 was reduced significantly. During 3.5 ± 1.5 months of follow-up miR-1 and -223 were back to baseline, whereas miR-92a and -99a return to normal levels over 3 months, but remained lower than healthy controls. Furthermore, monocytic expression of miR-143 was positively correlated with hs-CRP (R2 = 0.338; P < 0.031), but not with cTnT. Importantly, treatment of monocytes isolated from healthy individuals with INFγ, but not LPS or TNFα caused an upregulation of miR-143 and downregulation of miR-1. Our findings identify circulating monocytes as putative biomarkers and as novel carriers for the cell-specific transfer of miRs in the early phase of myocardial infarction.
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Affiliation(s)
- Mariana S Parahuleva
- Internal Medicine/Cardiology and Angiology, University Hospital of Giessen and Marburg, Marburg, Germany. .,Internal Medicine I/Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen, Germany.
| | - Gerhild Euler
- Institute of Physiology, Justus Liebig University, Giessen, Germany
| | - Amar Mardini
- Internal Medicine/Cardiology and Angiology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Behnoush Parviz
- Internal Medicine I/Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen, Germany
| | - Bernhard Schieffer
- Internal Medicine/Cardiology and Angiology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Rainer Schulz
- Institute of Physiology, Justus Liebig University, Giessen, Germany
| | - Muhammad Aslam
- Internal Medicine I/Cardiology and Angiology, University Hospital of Giessen and Marburg, Giessen, Germany
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12
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Hu X, Cheng J, Li C. Effects of rosuvastatin and atorvastatin on nonsustained ventricular tachycardia in patients with ST-elevation myocardial infarction: a retrospective analysis. Eur J Clin Pharmacol 2017; 74:29-35. [PMID: 28965256 DOI: 10.1007/s00228-017-2338-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 09/19/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND/AIMS Early and intensive atorvastatin treatment can decrease nonsustained ventricular tachycardia (nsVT) in patients with ST-segment elevation myocardial infarction (STEMI). The objective of this study was to compare the effects of hydrophilic rosuvastatin and lipophilic atorvastatin on nsVT in STEMI patients treated with primary percutaneous coronary intervention (PCI). METHODS The data from a cohort of patients undergoing primary PCI at Jinhua Municipal Central Hospital from January 1, 2013 through June 30, 2016 were analyzed. The patients were divided into the rosuvastatin group and the atorvastatin group based on which kind of statins that they had received. The endpoint of the study was the occurrence of nsVT on either electrocardiogram monitoring or Holter monitoring. RESULTS A total of 301 patients were enrolled in the study (rosuvastatin group: n = 103; atorvastatin group: n = 198). The baseline and procedural characteristics were similar between the two groups, except that total ischemic time in the rosuvastatin group was markedly longer than that in the atorvastatin group (8 (5-16) h vs. 6 (4-12) h; P = 0.001). The administration of rosuvastatin was significantly associated with lower occurrence of nsVT than that of atorvastatin (9.71 vs. 19.70%; P = 0.026). Multivariable logistic regression analysis suggested that the independent predictors of nsVT included rosuvastatin (odds ratio (OR) 0.397, 95% confidence interval (CI) 0.176-0.894), current smoking (OR 2.307, 95% CI 1.011-5.262), and left ventricular ejection fraction (LVEF) (OR 1.060, 95% CI 1.023-1.098). CONCLUSIONS The effects of rosuvastatin on nsVT might be better than that of atorvastatin in STEMI patients undergoing primary PCI.
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Affiliation(s)
- Xianqing Hu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.,Department of Cardiology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Jian Cheng
- Department of Cardiology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Chunjian Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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13
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Risk burdens of modifiable risk factors incorporating lipoprotein (a) and low serum albumin concentrations for first incident acute myocardial infarction. Sci Rep 2016; 6:35463. [PMID: 27748452 PMCID: PMC5066202 DOI: 10.1038/srep35463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 09/30/2016] [Indexed: 12/29/2022] Open
Abstract
Risk burdens of modifiable risk factors incorporating lipoprotein (a) (Lp(a)) and low serum albumin (LSA) concentrations for first incident acute myocardial infarction (AMI) haven’t been studied previously. Cross-sectional study of 1552 cases and 6125 controls was performed for identifying the association of risk factors with first incident AMI and their corresponding population attributable risks (PARs). Modifiable risk factors incorporating LSA and Lp(a) accounted for up to 92% of PAR for first incident AMI. Effects of these risk factors were different in different sexes across different age categories. Overall, smoking and LSA were the 2 strongest risk factors, together accounting for 64% of PAR for first incident AMI. After multivariable adjustment, Lp(a) and LSA accounted for 19% and 41%, respectively, and together for more than a half (54%) of PAR for first incident AMI. Modifiable risk factors incorporating LSA and Lp(a) have accounted for an overwhelmingly large proportion of the risk of first incident AMI, indicating most first incident AMI is preventable. The knowledge of risk burdens for first incident AMI incorporating Lp (a) and LSA may be beneficial for further reducing first incident AMI from a new angle.
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14
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Reddy K, Khaliq A, Henning RJ. Recent advances in the diagnosis and treatment of acute myocardial infarction. World J Cardiol 2015; 7:243-276. [PMID: 26015857 PMCID: PMC4438466 DOI: 10.4330/wjc.v7.i5.243] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/28/2014] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
The Third Universal Definition of Myocardial Infarction (MI) requires cardiac myocyte necrosis with an increase and/or a decrease in a patient’s plasma of cardiac troponin (cTn) with at least one cTn measurement greater than the 99th percentile of the upper normal reference limit during: (1) symptoms of myocardial ischemia; (2) new significant electrocardiogram (ECG) ST-segment/T-wave changes or left bundle branch block; (3) the development of pathological ECG Q waves; (4) new loss of viable myocardium or regional wall motion abnormality identified by an imaging procedure; or (5) identification of intracoronary thrombus by angiography or autopsy. Myocardial infarction, when diagnosed, is now classified into five types. Detection of a rise and a fall of troponin are essential to the diagnosis of acute MI. However, high sensitivity troponin assays can increase the sensitivity but decrease the specificity of MI diagnosis. The ECG remains a cornerstone in the diagnosis of MI and should be frequently repeated, especially if the initial ECG is not diagnostic of MI.
There have been significant advances in adjunctive pharmacotherapy, procedural techniques and stent technology in the treatment of patients with MIs. The routine use of antiplatelet agents such as clopidogrel, prasugrel or ticagrelor, in addition to aspirin, reduces patient morbidity and mortality. Percutaneous coronary intervention (PCI) in a timely manner is the primary treatment of patients with acute ST segment elevation MI. Drug eluting coronary stents are safe and beneficial with primary coronary intervention. Treatment with direct thrombin inhibitors during PCI is non-inferior to unfractionated heparin and glycoprotein IIb/IIIa receptor antagonists and is associated with a significant reduction in bleeding. The intra-coronary use of a glycoprotein IIb/IIIa antagonist can reduce infarct size. Pre- and post-conditioning techniques can provide additional cardioprotection. However, the incidence and mortality due to MI continues to be high despite all these recent advances. The initial ten year experience with autologous human bone marrow mononuclear cells (BMCs) in patients with MI showed modest but significant increases in left ventricular (LV) ejection fraction, decreases in LV end-systolic volume and reductions in MI size. These studies established that the intramyocardial or intracoronary administration of stem cells is safe. However, many of these studies consisted of small numbers of patients who were not randomized to BMCs or placebo. The recent LateTime, Time, and Swiss Multicenter Trials in patients with MI did not demonstrate significant improvement in patient LV ejection fraction with BMCs in comparison with placebo. Possible explanations include the early use of PCI in these patients, heterogeneous BMC populations which died prematurely from patients with chronic ischemic disease, red blood cell contamination which decreases BMC renewal, and heparin which decreases BMC migration. In contrast, cardiac stem cells from the right atrial appendage and ventricular septum and apex in the SCIPIO and CADUCEUS Trials appear to reduce patient MI size and increase viable myocardium. Additional clinical studies with cardiac stem cells are in progress.
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15
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Labaf A, Carlwe M, Svensson PJ. Efficacy and safety of novel oral anticoagulants in clinical practice: a report from three centers in Sweden. Thromb J 2014; 12:29. [PMID: 25506268 PMCID: PMC4265344 DOI: 10.1186/s12959-014-0029-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/04/2014] [Indexed: 12/27/2022] Open
Abstract
Introduction In clinical trials new oral anticoagulants (NOAC) have proved to be
as effective as warfarin for thromboprophylaxis in atrial fibrillation. The aim of
this study was to evaluate the efficacy and safety of these drugs in clinical
practise. Methods and results All patients treated with new oral anticoagulants at Skåne
University hospital and Halland County Hospital Halmstad between 2009 and
September 2013 was identified in the Swedish national quality registry for atrial
fibrillation and anticoagulation (AuriculA). Medical records were reviewed to
identify thromboembolism and major bleeding and compared to a warfarin cohort with
a time in therapeutic range (TTR) of 76%. There were 826 patients, mean age 70.6,
follow up 591 years, with atrial fibrillation treated with NOAC. Dabigatran was
the initial drug in 79% of the cohort. The incidences of ischemic stroke/ TIA and
major bleeding were 1.9 (95% CI; 1.0-3.2) and 2.0 (95% CI; 1.1-3.5) per 100
patient-years respectively. The corresponding incidences for warfarin were 1.5
(95% CI; 1.0-2.2) and 2.5 (95% CI; 1.8-3.3), with no statistical significance
between the groups. Two subdural hematomas occurred 0.4 (95% CI; 0.06-1.1) per 100
patient-years. Mean age of patients with complications was 77.9 (±5.9) and 69.3
(±11.3) for those without (p < 0.001). The discontinuation rate was 6.5% and
1.7% was due to dyspepsia for dabigatran, lower than the RE-LY trial. Conclusion This study, largely based on dabigatran shows that treatment is
efficient and safe in everyday clinical practice and not significantly different
compared to a warfarin cohort with tight anticoagulation control. Electronic supplementary material The online version of this article (doi:10.1186/s12959-014-0029-6) contains supplementary material, which is available to authorized
users.
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Affiliation(s)
- Ashkan Labaf
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Martin Carlwe
- Department of Medicine, Hallands Hospital, Halmstad, Sweden
| | - Peter J Svensson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Coagulation disorders, Skåne University Hospital, 205 02 Malmö, Sweden
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16
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Bacaksiz A, Vatankulu MA, Kayrak M, Telli HH, Ayhan SS, Sonmez O, Alp A, Buyukbas S. Assessment of the left atrial volume index and plasma NT-proANP level in patients with acute ST-elevation myocardial infarction. Clinics (Sao Paulo) 2013; 68:997-1003. [PMID: 23917666 PMCID: PMC3714741 DOI: 10.6061/clinics/2013(07)18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 03/30/2013] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Acute ST-elevation myocardial infarction is associated with ventricular dysfunction due to ischemia-induced progressive myocardial damage. The decrease in ventricular compliance causes left atrial dilatation and stretching of the atrial myocardium, which are the main stimuli for the secretion of atrial natriuretic peptide. The aim of this study was to evaluate left atrial dimensions and atrial natriuretic peptide levels in patients early after their first acute ST-elevation myocardial infarction and assess the probable interaction between coronary lesions and these measurements. METHODS A total of 110 patients with acute myocardial infarction and 50 controls were studied. Plasma atrial natriuretic peptide was measured at admission. Left ventricular function, diameter, and volume index were evaluated using transthoracic echocardiography. Gensini and vessel scores of the patients who underwent coronary angiography were calculated. RESULTS Plasma atrial natriuretic peptide in the patients with myocardial infarction was increased compared with that in controls (3.90±3.75 vs. 1.35±0.72 nmol/L, p<0.001). Although the left atrial diameter was comparable in patients and controls, the left atrial volume index was increased in patients with acute myocardial infarction (26.5±7.1 vs. 21.3±4.9 mL/m2, p<0.01). Multivariate regression analysis showed a strong independent correlation between the left atrial volume index and the plasma atrial natriuretic peptide level (β=0.23, p=0.03). CONCLUSIONS The left atrial volume index and plasma atrial natriuretic peptide level were correlated in patients with acute myocardial infarction.
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Affiliation(s)
- Ahmet Bacaksiz
- Department of Cardiology, Faculty of Medicine, Bezmialem Foundation University, Istanbul, Turkey.
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