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Wu G, Wu Z, Xu B, Chen S, Su W, Liu Y, Wu T, Shen Q, Zong G. Slow-Reflow and Prognosis in Patients with High Parathyroid Hormone Levels Undergoing Primary Percutaneous Coronary Intervention for Acute ST-Segment Elevation Myocardial Infarction. J Cardiovasc Transl Res 2023:10.1007/s12265-023-10457-8. [PMID: 37962823 DOI: 10.1007/s12265-023-10457-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
We aimed to evaluate the correlation among serum parathyroid hormone (PTH) and slow-reflow during primary percutaneous coronary intervention (PCI) and prognosis in patients with ST-segment elevation myocardial infarction (STEMI). A total of 262 patients were enrolled and divided into a slow-reflow group (n = 61) and a control group (n = 201). PTH was an independent risk factor for slow-reflow (P < 0.05), and the regression model had good discrimination and calibration. ROC curve analysis showed that PTH (≥ 63.65 pg/ml) had a predictive value for slow-reflow (P < 0.001). During the 1-year follow-up, the patients were divided into a PTH-h group (≥ 63.65 pg/ml, n = 100) and a PTH-l group (< 63.65 pg/ml, n = 162). Readmission for HF was independently associated with PTH levels (P < 0.05). KM survival analysis suggested that PTH-h had a predictive value for MACEs, especially for readmission for HF (P < 0.05). PTH levels were associated with slow-reflow during PCI and MACEs during follow-up in patients with STEMI.
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Affiliation(s)
- Gangyong Wu
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China.
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China.
| | - Zufei Wu
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The Affiliated Xuancheng Hospital of Wannan Medical College, Xuancheng, 242000, Anhui, People's Republic of China
| | - Baida Xu
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Shi Chen
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Wentao Su
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Yehong Liu
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Ting Wu
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Qin Shen
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China
| | - Gangjun Zong
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, 214044, People's Republic of China.
- Department of Cardiology, The 904Th Hospital of the PLA Joint Logistics Support Force, Wuxi, 214044, Jiangsu, People's Republic of China.
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Sun B, Wang CY, Chen RR. Clinical Efficacy and Safety of Early Intravenous Administration of Beta-Blockers in Patients Suffering from Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure Undergoing Primary Percutaneous Coronary Intervention: A Study-Level Meta-Analysis of Randomized Clinical Trials. Cardiovasc Drugs Ther 2023:10.1007/s10557-023-07448-x. [PMID: 37002468 DOI: 10.1007/s10557-023-07448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Several clinical studies have produced diverse results regarding the efficacy and safety of early intravenous beta-blockers in patients with acute ST-segment elevation myocardial infarction (STEMI). A study-level meta-analysis of randomized clinical trials (RCTs) comparing early intravenous beta-blockers versus placebo or routine care in STEMI patients undergoing primary percutaneous coronary intervention (PCI) was performed. METHODS A database search was conducted using PubMed, EMBASE, the Cochrane Library, and Clinicaltrials.gov for randomized clinical trials (RCTs) that compared intravenous beta-blockers versus placebo or routine care in STEMI patients who underwent primary PCI. The efficacy outcomes were infarct size (IS, % of LV) and the myocardial salvage index (MSI) based on magnetic resonance imaging, electrocardiographic findings, heart rate, ST-segment reduction percent (STR%), and complete STR. Safety outcomes included arrhythmias in the first 24 h (ventricular tachycardia and fibrillation [VT/VF], atrial fibrillation [AF], bradycardia, and advanced atrioventricular [AV] block), cardiogenic shock and hypotension during hospitalization, left ventricular ejection fraction (LVEF), and major adverse cardiovascular events (cardiac death, stroke, reinfarction, and heart failure readmission) at follow-up. RESULTS Seven RCTs with 1428 patients were included in this study, with 709 patients in the intravenous beta-blockers and 719 in the control group. Intravenous beta-blockers improved MSI compared to the control group (weighted mean difference [WMD] 8.46, 95% confidence interval [CI] 3.12-13.80, P = 0.002, I2 = 0%), but no differences were observed in IS (% of LV) between groups. Compared to the control group, the intravenous beta-blockers group had a lower risk of VT/VF (relative risk [RR] 0.65, 95% CI 0.45-0.94, P = 0.02, I2 = 35%) without an increase of AF, bradycardia, and AV-block and significantly decreased HR, hypotension. LVEF at 1 week ± 7 days (WMD 2.06, 95% CI 0.25-3.88, P = 0.03, I2 = 12%) and 6 months ± 7 days (WMD 3.24, 95% CI 1.54-4.95, P = 0.0002, I2 = 0%) was improved in the intravenous beta-blockers group compared to the control group. Subgroup analysis showed that intravenous beta-blockers before PCI decreased the risk of VT/VF and improved LVEF compared to the control group. Furthermore, sensitivity analysis showed that patients with a left anterior descending (LAD) artery lesion had a smaller IS (% of LV) in the intravenous beta-blockers group compared to the control group. CONCLUSION Intravenous beta-blockers improved the MSI, decreased the risk of VT/VF in the first 24 h, and were associated with increased LVEF at 1 week and 6 months following PCI. In particular, intravenous beta-blockers started before PCI is beneficial for patients with LAD lesions.
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Affiliation(s)
- Bing Sun
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Chi Yao Wang
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China
| | - Rui Rui Chen
- Department of Cardiology, Tang Du Hospital, Air Force Medical University, Shaanxi, China.
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Wang L, Ma Y, Jin W, Zhu T, Wang J, Yu C, Zhang F, Jiang B. Coronary microcirculation dysfunction evaluated by myocardial contrast echocardiography predicts poor prognosis in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovasc Disord 2022; 22:572. [PMID: 36577944 PMCID: PMC9795674 DOI: 10.1186/s12872-022-02947-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/10/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The mortality rate of acute ST-segment elevation myocardial infarction (STEMI) remains substantial, despite advances in treatment strategies. Coronary microcirculation dysfunction (CMD) persists after percutaneous coronary intervention (PCI) in a substantial proportion of STEMI patients. The association between CMD assessed using myocardial contrast echocardiography (MCE) and prognosis requires further elucidation. This study aimed to evaluate the impact of CMD after successful PCI on the prognosis of patients with STEMI. METHODS We enrolled 167 patients with STEMI after PCI who underwent MCE during hospitalization between January 2018 and March 2022. Patients were classified into the CMD and non-CMD groups according to the results of MCE. The clinical data and MCE results of both groups were analyzed. Follow-up was conducted for major adverse cardiac events. RESULTS MCE detected CMD in 105 patients (62.9%). The CMD group contained fewer hypertensive patients (55.2% versus 74.2%, P = 0.015). Patients with CMD exhibited significantly higher levels of plasma troponin I (TnI) [73.2 (23.0-124.0) versus 28.9 (12.7-80.2) ng/mL, P = 0.004], higher levels of plasma B-type natriuretic peptide [255 (99-641) versus 193 (59-389) pg/mL, P = 0.004], poorer Killip classification (P = 0.038), and different culprit vessels (P < 0.001) compared to the non-CMD group. Patients with CMD exhibited lower left ventricular ejection fraction [50 (43-58) versus 61 (54-67) %, P < 0.001], poorer wall motion score index values (1.68 ± 0.4 versus 1.31 ± 0.26, P < 0.001) and poorer left ventricular global longitudinal strain [-11.2 (-8.7 to -14.1) versus -13.9 (-11.0 to -17.2) %, P < 0.001] compared to the non-CMD group. Patients underwent follow-up for 13 (7-20) months. After adjusting for hypertension, peak TnI level, culprit vessel, and Killip classification, CMD was an independent predictor of total major adverse cardiac events at 13 months' follow-up [adjusted odds ratio (OR), 2.457; 95% confidence interval (CI), 1.042-5.790; P = 0.040], and patients with CMD had a higher risk of hospitalization for heart failure (adjusted OR, 5.184; 95% CI, 1.044-25.747; P = 0.044) and repeat myocardial infarction (adjusted OR, 2.896; 95% CI, 1.109-7.565; P = 0.030). CONCLUSIONS MCE is a safe and effective method for detecting CMD in patients with STEMI. CMD detected by MCE after successful PCI in patients with STEMI is a common occurrence, which is associated with a significantly worse prognosis, especially hospitalization for heart failure and repeat myocardial infarction.
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Affiliation(s)
- Lan Wang
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Yuliang Ma
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Wenying Jin
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Tiangang Zhu
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Jing Wang
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Chao Yu
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Feng Zhang
- grid.411634.50000 0004 0632 4559Department of Cardiology, Peking University People’s Hospital, Beijing, China ,Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Beijing, China ,grid.411634.50000 0004 0632 4559Center for Cardiovascular Translational Research, Beijing, China
| | - Bailin Jiang
- grid.411634.50000 0004 0632 4559Department of Anesthesiology, Peking University People’s Hospital, Beijing, China
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Ma Y, Wang L, Jin W, Zhu T, Liu J, Zhao H, Wang J, Lu M, Cao C, Jiang B. Left ventricular function and coronary microcirculation in patients with mild reduced ejection fraction after STEMI. BMC Cardiovasc Disord 2022; 22:423. [PMID: 36154928 PMCID: PMC9511738 DOI: 10.1186/s12872-022-02846-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/13/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The characteristics of heart failure (HF) with mildly reduced ejection fraction (EF) (HFmrEF) overlap with those of HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF) and need to be further explored. This study aimed to evaluate left ventricular (LV) function and coronary microcirculation in patients with mildly reduced ejection fraction after acute ST-segment elevation myocardial infarction (STEMI). METHODS We enrolled 119 patients with STEMI who had undergone speckle tracking imaging and myocardial contrast echocardiography during hospitalization from June 2016 to June 2021. They were classified into normal, HFmrEF, and HFrEF groups according to their left ventricular EF (LVEF): ≥ 50%, 40-50%, and ≤ 40%, respectively. The data of the HFmrEF group were analyzed and compared with those of the normal and HFrEF groups. RESULTS HFmrEF was observed in 32 patients (26.9%), HFrEF in 17 (14.3%), and normal LVEF in 70 patients (58.8%). The mean global longitudinal strain (GLS) of all patients was - 11.9 ± 3.8%. The GLS of HFmrEF patients was not significantly different from that of the HFrEF group (- 9.9 ± 2.5% and - 8.0 ± 2.3%, respectively, P = 0.052), but they were both lower than that of the normal group (- 13.8% ± 3.5%, P < 0.001). The HFmrEF group exhibited significantly poorer myocardial perfusion index (1.24 ± 0.33) than the normal group (1.08 ± 0.14, P = 0.005) but displayed no significant difference from the HFrEF group (1.18 ± 0.19, P = 0.486). Moreover, a significant difference in the incidence of regional wall motion (WM) abnormalities in the three groups was observed (P = 0.009), and the WM score index of patients with HFmrEF was 1.76 ± 0.30, similar to that of patients with HFrEF (1.81 ± 0.43, P = 0.618), but poorer than that in the normal group (1.33 ± 0.25, P < 0.001). CONCLUSIONS GLS is a more sensitive tool than LVEF for detecting LV systolic dysfunction. The LV systolic function, coronary microcirculation, and WM in patients with HFmrEF was poorer than that of patients with normal LVEF, but comparable to that in patients with HFrEF. Patients with HFmrEF after STEMI require more attention and appropriate management.
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Affiliation(s)
- Yuliang Ma
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Lan Wang
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Wenying Jin
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Tiangang Zhu
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Jian Liu
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Hong Zhao
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Jing Wang
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Mingyu Lu
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Chengfu Cao
- grid.411634.50000 0004 0632 4559Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction; Center for Cardiovascular Translational Research, Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Bailin Jiang
- grid.411634.50000 0004 0632 4559Department of Anesthesiology and Pain Medicine, Peking University People’s Hospital, Beijing, China
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Tang X, Li R, Ma L, Zhang T. Application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy. Pak J Med Sci 2022; 38:172-178. [PMID: 35035421 PMCID: PMC8713192 DOI: 10.12669/pjms.38.1.4545] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/03/2021] [Accepted: 08/26/2021] [Indexed: 01/18/2023] Open
Abstract
Objectives: To investigate the application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy. Methods: Two hundred patients with acute ST-segment elevation myocardial infarction (STEMI) complicated with diabetes who underwent percutaneous coronary intervention (PCI) and found to have high thrombus burden in coronary artery admitted to our hospital from September 2018 to September 2020 were selected as subjects, and were divided into two groups according to the randomization method: the intravenous tirofiban bolus group and the intracoronary tirofiban bolus group, with 100 cases in each group. The levels of LVEF, LVESD and LVEDD were detected immediately after admission and 15 days after therapy, and the enzyme-linked immunosorbent assay was utilized to detect the levels of CK-MB, MMP-9 and hs-CRP. Furthermore, the levels of BNP, TNI, CR and UREA of the patients were analyzed, and the levels of ESR and FIB were detected with an automatic blood rheology analyzer to analyze the TIMI classification and the incidence of MACE in the two groups. Results: Significant differences were seen between the two groups in the levels of various indicators after therapy. Fifteen days after therapy, the levels of LVEF and LVEDD were higher and the level of LVESD was lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p<0.05); 3d after therapy, the levels of CK-MB, MMP-9 and BNP in the intracoronary tirofiban bolus group were lower than those in the intravenous tirofiban bolus group (p<0.05); 3d after therapy, the levels of TNI (p<0.05), CR and UREA in the intracoronary tirofiban bolus group were lower than those in the intravenous tirofiban bolus group, with no statistical difference (p>0.05); Similarly, 3d after therapy, the levels of TNI, Cr and Urea, as well as ESR, FIB and hs-CRP were lower in the intracoronary tirofiban bolus group than in the intravenous tirofiban bolus group (p<0.05). Compared with the intravenous tirofiban bolus group, the intracoronary tirofiban bolus group had a lower number of patients with Grade-0 and Grade-1, but a higher number of patients with Grade-2 and Grade-3 (p<0.05); Moreover, the incidence of MACE in the intracoronary tirofiban bolus group was lower than that in the intravenous tirofiban bolus group (p<0.05). Conclusion: In patients with STEMI complicated with diabetes who underwent PCI and found to have high thrombus burden in coronary artery, intracoronary bolus of tirofiban boasts superior therapeutic efficacy over intravenous bolus of tirofiban in significantly improving cardiac function, reducing myocardial cell damage, and improving renal function and myocardial inflammation of patients.
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Affiliation(s)
- Xiuying Tang
- Xiuying Tang, Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, Hebei, China
| | - Runjun Li
- Runjun Li, Department of Critical Care Medicine, People's Hospital of Yangjiang, Yangjiang, 529500, Guangdong, China
| | - Lixiang Ma
- Lixiang Ma, Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, 066000, Hebei, China
| | - Ting Zhang
- Ting Zhang, Geriatrics Department, Baoding First Central Hospital, Baoding, 071000, Hebei, China
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Li X, Zeng Z, Yang X, Wang H. Predictive value of CHADS 2 and CHA 2DS 2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2021; 21:439. [PMID: 34525958 PMCID: PMC8442268 DOI: 10.1186/s12872-021-02257-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/08/2021] [Indexed: 01/02/2023] Open
Abstract
Objective To evaluate the predictive value of CHADS2 and CHA2DS2-VASc scores for coronary artery lesions and in-hospital prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 524 patients who were diagnosed with STEMI from January 2016 to August 2017 were retrospectively reviewed. The correlation between CHADS2 and CHA2DS2-VASc scores with the patients’ clinical data, number of coronary lesions, Gensini scores, the target vessel and hospitalization time and in-hospital adverse events (AEs) was analyzed. Results The number of coronary lesions in STEMI patients was mainly single and double lesions. The CHADS2 and CHA2DS2-VASc scores were not meaningful for predicting the number of coronary lesions. However, for left main coronary artery lesion, CHADS2 score was significantly increased when the number increased (P < 0.05), but CHA2DS2-VASc score showed no statistical difference (P > 0.05). The incidence of target lesions in STMEI patients was mainly left anterior descending coronary artery (LAD) and right coronary artery (RCA). The two scores were not meaningful for predicting target lesions (P > 0.05). For the severity of coronary lesions, there was positive correlation between CHADS2 score with Gensini score (P < 0.05), but no exact correlation between CHA2DS2-VASc score and Gensini score (P > 0.05). The stratifications of CHADS2 score and CHA2DS2-VASc score were significantly associated with hospitalization time and adverse events during hospitalization (P < 0.05). The high score group had longer hospitalization time and more AEs during hospitalization than the low score group and the middle group statistically (P < 0.05). Conclusion CHADS2 score had a certain value to predict the severity of coronary lesion and the presence of left main coronary artery in STEMI. The CHA2DS2-VASc score had no predictive ability to do it. There was no significant value in predicting the number of coronary lesions and the location of the target lesions in STEMI patients. However, both scores had the predictive ability for patient hospitalization and AEs during hospitalization.
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Affiliation(s)
- Xiaoli Li
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University; Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Zhen Zeng
- Geriatric Department, Chui Yang Liu Hospital, Tsinghua University, Beijing, 100022, China
| | - Xinchun Yang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University; Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Chaoyang District, Beijing, 100020, China
| | - Hongjiang Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University; Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, No.8 Gongti South Road, Chaoyang District, Beijing, 100020, China.
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Hao X, Huang D, Wang Z, Zhang J, Liu H, Lu Y. Study on the safety and effectiveness of drug-coated balloons in patients with acute myocardial infarction. J Cardiothorac Surg 2021; 16:178. [PMID: 34154628 PMCID: PMC8215732 DOI: 10.1186/s13019-021-01525-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Drug-coated balloon (DCB) is a new technology that has emerged in recent years and has been proven to be effective and safe in the treatment of in-stent restenosis. The purpose of this article is to observe the safety and effectiveness of drug-coated balloons in patients with acute myocardial infarction. METHOD We selected 80 patients admitted to the hospital for STEMI from January 2018 to December 2019. The subjects were randomly divided into a Yinyi (Liaoning) Biotech Bingo Drug Coated Balloon treatment group (balloon group, n = 38) and a drug-eluting stent (DES) treatment group (stent group, n = 42). Patients were followed up to understand the incidence of major adverse cardiovascular events (MACE) at 1 month, 6 months and 1 year after surgery. Coronary angiography was rechecked 1 year after surgery to understand the late lumen loss (LLL) in the two groups. RESULT During the one-year follow-up, the LLL of the target lesion in the balloon group was -0.12±0.46 mm, while the target lesion in the stent group was 0.14±0.37 mm ( P <0.05). Within 1 year, the incidence of MACE in the balloon group was 11%, while the incidence of MACE in the stent group was 12%. There was no significant difference between the two groups. IN CONCLUSION When PCI is used for STEMI, only DCB therapy is safe and effective, and has shown good clinical effects during a one-year follow-up period.
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Affiliation(s)
- Xiaojiao Hao
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China
| | - Damin Huang
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China
| | - Zhaoxia Wang
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China
| | - Jinchun Zhang
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China
| | - Hongqiang Liu
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China
| | - Yingmin Lu
- Xinhua Hospital Chongming Branch, Shanghai Jiaotong University, Nanmen Road, No. 25, Chongming District, Shanghai, 200000, China.
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Qi Y, Gu R, Xu J, Kang L, Liu Y, Wang L, Chen J, Zhang J, Wang K. Index of microcirculatory resistance predicts long term cardiac systolic function in patients with STEMI undergoing primary PCI. BMC Cardiovasc Disord 2021; 21:66. [PMID: 33530931 PMCID: PMC7852219 DOI: 10.1186/s12872-021-01887-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the predictive value of the index of microcirculatory resistance (IMR) for long-term cardiac systolic function after primary percutaneous coronary intervention (pPCI) in patients with acute anterior wall ST-segment elevation myocardial infarction (STEMI). Methods A total of 53 acute anterior wall STEMI patients were included and followed up within 1-year. IMR was measured to evaluate the immediate intraoperative reperfusion. IMR > 40 U was defined as the high IMR group and ≤ 40 U was defined as the low IMR group. Left ventricular ejection fraction (LVEF) was measured by echocardiography at 24 h, 1 month, 3 months, and 1 year after PCI to analyze the correlation between IMR and cardiac systolic function. Heart failure was estimated according to classification within one year. Results The ratio of TMPG (TIMI myocardial perfusion grade) 3 (85.7% vs. 52%, p = 0.015) and STR (ST-segment resolution) > 70% (82.1% vs. 48%, p = 0.019) were significantly higher in the low IMR group. The LVEF in the low IMR group was significantly higher than that in the high IMR group at 3 months (43.06 ± 2.63% vs. 40.20 ± 2.67%, p < 0.001) and 1 year (44.16 ± 2.40% vs. 40.13 ± 3.48%, p < 0.001). IMR was negatively correlated with LVEF at 3 months (r = − 0.1014, p = 0.0040) and 1 year (r = − 0.1754, p < 0.0001). Conclusions The IMR showed significant negative correlation with the LVEF value after primary PCI. The high IMR is a strong predictor of heart failure within 1 year after anterior myocardial infarction.
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Affiliation(s)
- Yu Qi
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Rong Gu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jiamin Xu
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Lina Kang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Yihai Liu
- Department of Cardiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, 210008, China
| | - Lian Wang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jianzhou Chen
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Jingmei Zhang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Kun Wang
- Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
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Fu XY, Shen XF, Cheng YR, Zhou MY, Ye L, Feng ZH, Xu Z, Chen J, Wang MW, Zhang XW. Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction. Am J Emerg Med 2020; 44:192-197. [PMID: 33039221 PMCID: PMC7494496 DOI: 10.1016/j.ajem.2020.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 01/30/2023] Open
Abstract
Objective To explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China. Methods We retrospectively reviewed the data of STEMI patients admitted to the Hangzhou Chest Pain Center (CPC) during a COVID-19 epidemic period in 2020 (24 cases) and the same period in 2019 (29 cases). General characteristics of the patients were recorded, analyzed, and compared. Moreover, we compared the groups for the time from symptom onset to the first medical contact (SO-to-FMC), time from first medical contact to balloon expansion (FMC-to-B), time from hospital door entry to first balloon expansion (D-to-B), and catheter room activation time. The groups were also compared for postoperative cardiac color Doppler ultrasonographic left ventricular ejection fraction (LVEF),the incidence of major adverse cardiovascular and cerebrovascular events (MACCE),Kaplan-Meier survival curves during the 28 days after the operation. Results The times of SO-to-FMC, D-to-B, and catheter room activation in the 2020 group were significantly longer than those in the 2019 group (P < 0.05). The cumulative mortality after the surgery in the 2020 group was significantly higher than the 2019 group (P < 0.05). Conclusion The pre-hospital and in-hospital treatment times of STEMI patients during the COVID-19 epidemic were longer than those before the epidemic. Cumulative mortality was showed in Kaplan-Meier survival curves after the surgery in the 2020 group was significantly different higher than the 2019 group during the 28 days.The diagnosis and treatment process of STEMI patients during an epidemic should be optimized to improve their prognosis.
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Affiliation(s)
- Xin-Yan Fu
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Xiang-Feng Shen
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Yong-Ran Cheng
- Zhejiang Academy of Medical Sciences, Hangzhou 310012, China; Hangzhou Medical college, Hangzhou 311300, China
| | | | - Lan Ye
- Basic medical college, Guizhou Medical University, Guizhou 550004, China
| | - Zhan-Hui Feng
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zhao Xu
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China.
| | - Juan Chen
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China
| | - Ming-Wei Wang
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China.
| | - Xing-Wei Zhang
- Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, China.
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Zhao X, Ai G, Qiu M, Wang X, Zhang L, Yang X, Liu Y, Xu P, Zhang J, Gu C, Zhou M, Hao Y, Zhao D, Han Y. Efficacy of clopidogrel and ticagrelor under NT-proBNP in hospitalized ST-elevation acute coronary syndrome patients on percutaneous coronary intervention: CCC-ACS Project Analysis. Int J Cardiol 2020; 310:1-8. [PMID: 32307186 DOI: 10.1016/j.ijcard.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/27/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Risk stratification with specific biomarkers is proposed for tailored P2Y12 inhibitor therapy in patients with STEMI. METHODS This nationwide registry and quality improvement study is from November 1, 2014, to June 30, 2017. In total, 11,512 STEMI patients received aspirin and P2Y12 receptor inhibitor (clopidogrel or ticagrelor) and underwent PCIs in hospitals. Of the patients, 2992 were prescribed ticagrelor and 8520 clopidogrel. The primary effectiveness outcome was major adverse cardiovascular and cerebrovascular events (MACCE: cardiac death, myocardial infarction, stent thrombosis, in-hospital ischemic stroke). The primary safety outcome was in-hospital major bleeding. RESULTS MACCE incidence was lower in the ticagrelor group than in the clopidogrel group (0.8% versus 1.2%; P=0.046), but under different NT-proBNP levels, cumulative hazards of MACCE were without statistical significance. Bleeding rates were higher in the ticagrelor group than in the clopidogrel group (all bleeding: 9.9% versus 6.9%, P<0.001; major bleeding: 4.0% versus 2.7%, P<0.001). The higher cumulative hazard of bleeding could be identified in the Kaplan-Meier curves. In the multivariate analysis, ticagrelor increased bleeding events, compared with clopidogrel, at NT-proBNP >1800 ng/L patients (all bleeding: HR 1.46; 95%CI, 1.07-2.01; major bleeding: HR 1.68, 95%CI, 1.03-2.74), but a low effect was found in those with lower NT-proBNP level. Subgroup analyses show that ticagrelor increased major bleeding in patients with left ventricular ejection fraction (LVEF) <0.50 (HR 3.29; 95% CI 1.61-6.74) (interaction p=0.03). CONCLUSION We found that ticagrelor, compared with clopidogrel, increased bleeding complications in hospitalized patients with NT-proBNP>1800 ng/L, especially in patients with EF < 0.50.
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Affiliation(s)
- Xin Zhao
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Guannan Ai
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China; Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Miaohan Qiu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Xiaozeng Wang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Lei Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China
| | - Xiaoxu Yang
- Department of Cardiology, The Second Affiliated Hospital of Shenyang Medical College, Shenyang, Liaoning 110016, China
| | - Yifei Liu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China; Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Pei Xu
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China; Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Jiyuan Zhang
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China; Jinzhou Medical University, Jinzhou, Liaoning 121001, China
| | - Chonghuai Gu
- Department of Cardiology, Anqing Hospital Affiliated to Anhui Medical University, Anqing, Auhui 246003, China
| | - Mengge Zhou
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing 100000, China
| | - Yongchen Hao
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing 100000, China
| | - Dong Zhao
- Department of Epidemiology, Beijing Anzhen Hospital, Beijing 100000, China
| | - Yaling Han
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning 110016, China.
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Qi L, Zhang J, Wu K, Shi S, Ji Q, Miao H, Que B. IL-19 as a Biomarker for the Severity of Acute Myocardial Infarction. Arch Med Res 2020; 51:160-166. [PMID: 32111500 DOI: 10.1016/j.arcmed.2020.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/06/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Interleukin-19 (IL-19) has been shown to be involved in coronary artery diseases and atherosclerosis, while its expression in myocardial infarction is poorly understood. In this study, the dynamic increase in circulating IL-19 in acute ST-segment elevation myocardial infarction (STEMI) patients was detected. METHOD Both plasma IL-19 levels and IL-19 mRNA expression in peripheral blood mononuclear cells (PBMCs) from STEMI patients and chest pain syndrome (CPS) patients were detected at different time points, including 1 d, 3 d, 7 d and 14 d after treatment and on admission. RESULTS Compared with the CPS patients, IL-19 levels and IL-19 gene expression were significantly increased in STEMI patients and peaked at 1 d. From 1-14 d, refocusing treatment, including emergency percutaneous coronary intervention (PCI) and thrombolysis, markedly reduced IL-19 expression and promoted its recovery; of the treatments, the effect of emergency PCI was most significant. In addition, similar trends were also observed with cTnI, NT-proBNP and C-reactive protein (CRP) levels. Furthermore, correlation analysis showed that IL-19 levels were positively correlated with cTnI, NT-proBNP, CRP levels and left ventricular ejection fraction (LVEF) in STEMI patients. CONCLUSIONS IL-19 is correlated with the severity of acute myocardial infarction, which may be a new idea for the clinical treatment of myocardial infarction.
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Affiliation(s)
- Liping Qi
- Department of Cardiology, The Second Clinical Center, Chinese PLA General Hospital, Beijing, China
| | - Jianwei Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Kui Wu
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Shutian Shi
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Qingwei Ji
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Huangtai Miao
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China
| | - Bin Que
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, and Beijing Lab for Cardiovascular Precision Medicine, Beijing, China.
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12
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Bai R, Yang Q, Xi R, Li L, Shi D, Chen K. miR-941 as a promising biomarker for acute coronary syndrome. BMC Cardiovasc Disord 2017; 17:227. [PMID: 28830367 PMCID: PMC5568367 DOI: 10.1186/s12872-017-0653-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 08/02/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Circulating miRNAs can function as biomarkers for diagnosis, treatment, and prevention of diseases. However, it is unclear whether miRNAs can be used as biomarkers for acute coronary syndrome (ACS). To this end, we applied gene chip technology to analyze miRNA expression in patients with stable angina (SA), non-ST elevation ACS (NSTE-ACS), and ST-segment elevation myocardial infarction (STEMI). METHODS We enrolled patients with chest pain who underwent diagnostic coronary angiography, including five patients each with SA, NSTE-ACS, or STEMI, and five controls without coronary artery disease (CAD) but with three or more risk factors. After microarray analysis, differential miRNA expression was confirmed by quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR). RESULTS Compared with those in patients with STEMI, differentially expressed microRNAs in controls and patients with SA or NSTE-ACS were involved in inflammation, protein phosphorylation, and cell adhesion. Pathway analysis showed that differentially expressed miRNAs were related to the mitogen-activated protein kinase signaling, calcium ion pathways, and cell adhesion pathways. Compared with their expression levels in patients with STEMI, miR-941, miR-363-3p, and miR-182-5p were significantly up-regulated (fold-change: 2.0 or more, P < 0.05) in controls and patients with SA or NSTE-ACS. Further, qRT-PCR showed that plasma miR-941 level was elevated in patients with NSTE-ACS or STEMI as compared with that in patients without CAD (fold-change: 1.65 and 2.28, respectively; P < 0.05). Additionally, miR-941 expression was significantly elevated in the STEMI group compared with that in the SA (P < 0.01) and NSTE-ACS groups (P < 0.05). Similarly, miR-941 expression was higher in patients with ACS (NSTE-ACS or STEMI) than in patients without ACS (without CAD or with SA; P < 0.01). There were no significant differences in miR-182-5p and miR-363-3p expression. The areas under the receiver operating characteristic curves were 0.896, 0.808, and 0.781 for patients in the control, SA, and NSTE-ACS groups, respectively, compared with that for patients with STEMI; that for the ACS group compared with the non-ACS group was 0.734. CONCLUSION miR-941 expression was relatively higher in patients with ACS and STEMI. Thus, miR-941 may be a potential biomarker of ACS or STEMI.
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Affiliation(s)
- Ruina Bai
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China
| | - Qiaoning Yang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China
| | - Ruixi Xi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China
| | - Lizhi Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China
| | - Dazhuo Shi
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China.
| | - Keji Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, 1 Xiyuan Caochang, Haidian district, Beijing, China
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13
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Wu PJ, Wang HT, Sung PH, Tong MS, Yang CH, Chen CJ, Lin CJ, Hsueh SK, Chung SY, Chung WJ, Hang CL, Wu CJ, Yip HK. No correlation between body mass index and 30-day prognostic outcome in Asians with acute ST-elevation myocardial infarction undergoing primary coronary intervention. Biomed J 2017; 40:169-177. [PMID: 28651739 PMCID: PMC6136285 DOI: 10.1016/j.bj.2016.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 12/18/2016] [Accepted: 12/27/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND This study investigated whether body mass index (BMI) was a risk factor predictive of 30-day prognostic outcome in Asians with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIAL AND METHODS Data regarding the impact of BMI on the prognostic outcome in Asian populations after acute STEMI is scarce. A number of 925 STEMI patients were divided into three groups according to the BMI: normal weight (<25 kg/m2), overweight (≥25.0 to <30.0 kg/m2) and obese (≥30.0 kg/m2). RESULTS The obese group was significantly younger with significantly higher incidences of smoking and diabetes mellitus. The incidences of multi-vessel disease, final thrombolysis in myocardial infarction (TIMI)-3 flow, advanced Killip score, advance congestive heart failure, 30-day mortality and combined 30-day major adverse clinical outcome (MACO) did not differ among the three groups. Multiple regression analysis showed the age, unsuccessful reperfusion and lower left ventricular ejection fraction were most significant and independent predictor of 30-day mortality. CONCLUSION BMI is not a predictor of 30-day prognostic outcome in Asians with STEMI undergoing primary PCI.
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Affiliation(s)
- Po-Jui Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ting Wang
- Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Kai Hsueh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Jung Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan.
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Celik T, Balta S, Ozturk C, Iyisoy A. Survival of the young patients with acute ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention: Does gender matters? Int J Cardiol 2016; 210:54-5. [PMID: 26925922 DOI: 10.1016/j.ijcard.2016.02.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/14/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Turgay Celik
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey.
| | - Sevket Balta
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Cengiz Ozturk
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Atila Iyisoy
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
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15
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Chen WR, Tian F, Chen YD, Wang J, Yang JJ, Wang ZF, Da Wang J, Ning QX. Effects of liraglutide on no-reflow in patients with acute ST-segment elevation myocardial infarction. Int J Cardiol 2015; 208:109-14. [PMID: 26849684 DOI: 10.1016/j.ijcard.2015.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/30/2015] [Accepted: 12/12/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The 'no-reflow' phenomenon after a percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) is a strong predictor of both short- and long-term mortality. Glucagon-like peptide-1 (GLP-1) exerts a cardioprotective effect during ischemia reperfusion injury. We planned to evaluate the effects of liraglutide on myocardial no-reflow after PCI for STEMI. METHODS A total of 284 patients with STEMI undergoing PCI were enrolled in this study between September 2013 and March 2015. Of these, 210 patients were randomized 1:1 to receive either liraglutide or placebo 30 min before PCI (1.8 mg). RESULTS The primary end point, the prevalence of no-reflow, was significantly lower in the liraglutide group than in the control group (5% vs. 15%, P=0.01). Administration of liraglutide was consistently identified as a significant determinant for no-reflow ratio. There was a significant decrease in serum high-sensitivity C-reactive protein levels at 6-hour reperfusion in the liraglutide group compared to the control group (0.87 ± 0.09 mg/dL vs. 0.96 ± 0.10mg/dL, P<0.001). During a 3-month follow-up period, no difference was observed in the incidence of major adverse cardiovascular event. CONCLUSIONS Liraglutide may be associated with less no-reflow in STEMI, which should be confirmed by larger-scale trials.
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Affiliation(s)
- Wei Ren Chen
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Feng Tian
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Yun Dai Chen
- Department of Cardiology, PLA General Hospital, at Beijing, China.
| | - Jing Wang
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Jun Jie Yang
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Zhi Feng Wang
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Jin Da Wang
- Department of Cardiology, PLA General Hospital, at Beijing, China
| | - Qing Xiu Ning
- Department of Cardiology, PLA General Hospital, at Beijing, China
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Sarathy K, Nagaraja V, Kapur A, Szirt R, Raval J, Eslick GD, Burgess D, Denniss AR. Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: a meta-analysis of randomised trials. Heart Lung Circ 2014; 24:327-34. [PMID: 25547531 DOI: 10.1016/j.hlc.2014.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 09/10/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In acute ST-segment elevation myocardial infarction (STEMI), coronary reperfusion with percutaneous coronary intervention (PCI) to treat the culprit lesion responsible for infarction improves clinical outcomes in nearly all patients. The concurrent treatment of non-infarct vessels with significant stenoses during initial angiography remains an area of controversy. METHODS A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library, Google Scholar, Science Direct, and Web of Science. Original data were abstracted from each study and used to calculate a pooled odds ratio (OR) and 95% confidence interval (95% CI). RESULTS Only four randomised trials comprising 775 patients met full criteria for analysis. The incidence of non-fatal MI (3.25% vs 8.51%, OR: 0.376, 95% CI: 0.192-0.763), refractory angina (4.01% vs 9.57%, OR: 0.400, 95% CI: 0.241-0.741) and repeat revascularisation (10.52% vs 24.20%, OR: 0.336, 95% CI: 0.202-0.661) was lower in the multivessel revascularisation cohort. Death from cardiac causes or refractory angina or non-fatal MI (11.78% vs 28.86%, OR: 0.336, 95% CI: 0.223-0.505) and death from cardiac causes or non-fatal MI (5.26% vs 12.76%, OR: 0.420, 95% CI: 0.245-0.722) were significantly lower in the multivessel revascularisation cohort. The Median Contrast Volume and Procedure Length were similar in both cohorts. CONCLUSIONS In patients with acute STEMI who undergo primary PCI, a strategy of treatment of significant non-infarct stenosis (preventive PCI) in addition to the culprit lesion responsible for infarction may result in improved cardiovascular outcomes and reduced overall mortality; however there is insufficient data to fully validate this from currently published literature.
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Affiliation(s)
- Kiran Sarathy
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Vinayak Nagaraja
- Prince of Wales Hospital, University of New South Wales, Sydney; The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney
| | - Amit Kapur
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Richard Szirt
- Prince of Wales Hospital, University of New South Wales, Sydney
| | - Jwalant Raval
- Department of Cardiology, Blacktown Hospital, Sydney.
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, University of Sydney, Nepean Hospital, Sydney
| | - David Burgess
- Department of Cardiology, Blacktown Hospital, Sydney
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17
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Udayakumaran K, Subban V, Pakshirajan B, Lakshmanan A, Kalidoss L, Rajaram RS, Janakiraman E, Mullasari S A. Primary percutaneous thrombus aspiration alone as definitive intervention for left main coronary artery occlusion presenting as acute anterior wall ST elevation myocardial infarction. Heart Lung Circ 2013; 23:166-70. [PMID: 23973559 DOI: 10.1016/j.hlc.2013.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 07/09/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
Primary angioplasty and stenting remains the standard of care for patients presenting with acute ST-segment elevation myocardial infarction. Recently, thrombus aspiration has been shown to improve the myocardial perfusion and outcomes in STEMI. In a subset of patients thrombus aspiration may result in optimal perfusion and minimal residual stenosis. These patients may be managed without additional stenting. Three patients with anterior wall STEMI were successfully managed with thrombus aspiration alone without additional stenting. All three are doing well at 30 day follow up with significant improvement in left ventricular ejection fraction.
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Affiliation(s)
- Kalaichelvan Udayakumaran
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India.
| | - Vijayakumar Subban
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Balaji Pakshirajan
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Anitha Lakshmanan
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Latchumanadhas Kalidoss
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Ramkumar Soli Rajaram
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Ezhilan Janakiraman
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Ajit Mullasari S
- Department of Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
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18
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Shin SK, Jin SA, Park YK, Park JH. A Case of Acute ST-Segment Elevation Myocardial Infarction Mimicking Stress Induced Cardiomyopathy; Demonstration of Typical Echocardiographic Finding Correlated with Unusual Distribution of Left Anterior Descending Coronary Artery. J Cardiovasc Ultrasound 2010; 18:101-3. [PMID: 20967158 DOI: 10.4250/jcu.2010.18.3.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/03/2010] [Accepted: 08/17/2010] [Indexed: 12/18/2022] Open
Abstract
Stress-induced cardiomyopathy (SCMP) is diagnosed in 1-2% of patients presenting with symptoms suggestive of acute coronary syndrome. Because of sharing many common clinical features with SCMP, acute ST-segment elevation myocardial infarction (STEMI) can be misdiagnosed as SCMP. However, it can be associated with fatal outcome of the patient. Also, diagnosis of SCMP seems to be always challenging to clinicians, especially in the decision of taking coronary angiography which is still invasive and even risky. Here, we present a case with acute STEMI mimicking SCMP as a result of anatomical variation of coronary circulation. In this patient, prompt and early coronary angiography and stent implantation was very helpful.
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Affiliation(s)
- Sung Kyun Shin
- Cardiology Division of Internal Medicine, Cardiocerebrovascular Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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