急性心肌梗死的治疗进展

急性冠脉综合征(ACS)是近年来提出的新概念,按ST段抬高与否,分为ST段抬高及非ST段抬高的ACS.ST段抬高的ACS主要演变为Q波型急性心肌梗死(AMI),非ST段抬高的ACS主要演变为非Q波型心肌梗死和不稳定型心绞痛两大类.     

急性冠脉综合征诊断

急性冠脉综合征(acute coronary syndrome,ACS)是与急性冠状脉缺血相关的一组临床综合征.根据心电图ST段的表现分为ST段抬高型和非ST段抬高型.ST段抬高型即ST段抬高性心肌梗死,非ST段抬高型又分为不稳定性心绞痛和非ST段抬高性心肌梗死.……     

成纤维细胞生长因子21与急性冠状动脉综合征关系的研究进展

<正>急性冠状动脉综合征(acute coronary syndrome,ACS)是冠状动脉粥样硬化性心脏病(冠心病)中的危重临床类型,其主要包括不稳定型心绞痛、非ST段抬高型心肌梗死和ST段抬高型心肌梗死[1]。近年来为更好地指导临床早期治疗方案,特别是心肌再灌注策略的制定,又将前两者合称为非ST段抬高型ACS(约占ACS的3/4),将后者称为ST段抬高型ACS(约占ACS的1/4)。ACS具有共同的病理生理机制,而又因心肌缺血程度、     

老年非ST段抬高急性冠状动脉综合征的抗栓治疗

急性冠状动脉综合征(ACS)包括不稳定性心绞痛、非ST段抬高心肌梗死(NSTEMI)即非ST段抬高急性冠状动脉综合征(NSTE ACS)和ST段抬高心肌梗死,ACS是老年人中的常见病和主要死亡原因之一。随着我国人口老龄化进程的加速,老年ACS患病率正逐年上升。尽管近年来,ACS治疗方法和策略已使     

急性冠脉综合征:危急值解读

<正>急性冠状动脉综合征(ACS)是以冠状动脉粥样硬化斑块破裂或侵袭,局部血栓形成,继发完全或不完全冠脉闭塞为病理基础的临床综合征。根据患者发病时的心电图ST段是否抬高,可以将ACS分为急性ST段抬高型心肌梗死(STEMI)和非ST段抬高型急性冠状动脉综合征(NSTE-ACS)。理论认为,冠脉急性完全闭塞可形成STEMI;如果冠脉不完全闭塞,则无ST段抬高,而     

53例非ST段抬高型急性心肌梗死的临床特征分析

近年来,我们将急性冠状动脉综合征(ACS)分为ST段抬高型、非ST段抬高型急性心肌梗死和不稳定型心绞痛,ST段抬高型和非sT段抬高型急性心肌梗死在病理生理、临床表现、治疗方案的合理选择以及预后等诸多方面都不尽相同.本文回顾性分析总结了53例非sT段抬高型急性心肌梗死的临床特征,旨在探讨其病变发生原因和对治疗的指导意义.     

急性冠脉综合征与电风暴

<正>急性冠脉综合征(ACS)引起的恶性室性心律失常可发生于急性ST段抬高型心肌梗死(STEMI),急性非ST段抬高型心肌梗死(NSTEMI)和不稳定型心绞痛(UA)。ACS导致的死亡病例中,一半左右为猝死,而猝死的主要原因为恶性室性心律失常(VA,包括     

中医药对急性冠脉综合征C反应蛋白影响的研究进展

急性冠脉综合征(acute coronary syndrome,ACS)涵盖了从不稳定型心绞痛(UA)、急性非ST段抬高型心肌梗死(NSTEMI)到ST段抬高型心肌梗死(STEMI)的一系列临床病理状态.     

急性冠状动脉综合征的诊治进展

急性冠状动脉综合征（acute coronary syndrome,ACS）是近年来提出的新概念,按ST段抬高与否,分为ST段抬高及非ST段抬高的ACS。ST段抬高的ACS主要演变为Q波型急性心肌梗死（AMI）,非ST段抬高的ACS主要演变为非Q波型心肌梗死和不稳定型心绞痛两大类。ACS是以冠状动脉粥样硬化斑块破裂或侵蚀,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征,是常见的致死性疾病之一。     

急性冠脉综合征诊治的研究进展

急性冠脉综合征(acute coronary syndrome, ACS)是冠状动脉内不稳定性斑块破裂引起血栓形成而导致的心脏急性严重缺血综合征.按2002年美国ACC/AHA有关ACS的治疗指南[1].根据心电图有无ST段持续抬高,可将ACS分为ST段抬高和非ST段抬高两大类,前者主要为ST段抬高心肌梗死(STEMI:大多为Q-MI,少数为N-QMI);后者包括不稳定型心绞痛(UAP)和非ST段抬高心肌梗死(NSTEMI,大多为N-QMI,少数为Q-MI)及猝死型冠心病.     

Detection of atherosclerotic coronary artery plaques by multislice spiral computed tomography in patients with acute coronary syndrome: report of 2 cases.

Multislice spiral computed tomography (MSCT) is a new non-invasive imaging technique for detecting coronary artery disease. It allows direct visualization of not only the lumen of the coronary arteries, but also plaque within the artery. Identification of soft plaques is of the utmost importance in the therapeutic decision making for patients with acute coronary syndrome (ACS), including acute myocardial infarction and unstable angina pectoris. MSCT detected coronary artery soft plaques in 2 cases of ACS.     

Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome

Cardiovascular disease(CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently,advances in monitoring,revascularisation and pharmacotherapy have resulted in a reduction in mortality. However,although mortality rates have declined,the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia,acute coronary syndrome(ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually.It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS,aid in the risk stratification of de novo coronary artery disease and avail incrementalinformation of prognostic value such as viability which cardiovascular magnetic resonance(CMR) allows. Despite its manifold benefits,there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols,CMR could be made less cumbersome,its imaging protocols less lengthy,the technology more inexpensive and easily applied in routine clinical practice.     

非冠状动脉粥样硬化引发急性冠脉综合征临床研究进展

在没有阻塞性动脉粥样硬化性冠状动脉疾病的情况下,多数的患者发生了急性冠脉综合症（ACS）。非冠状动脉粥样硬化引发ACS重要的病因有5个包括:自发性冠状动脉夹层（SCAD）、冠状动脉栓塞、冠状动脉血管痉挛（CAS）、冠脉心肌桥（MB）和应激性心肌病。本文对每种病因的发病机制、诊断和治疗策略进行了综述。     

Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease

Chronic kidney disease is a worldwide growing problem in public health. It is a risk factor for complications in patients with acute coronary syndrome (ACS). Diabetes, hypertension (hypertrophy and left ventricular failure), impaired fibrinolysis and coagulation processes, as well as the rapid development of atherosclerosis (partly associated with chronic inflammation) are responsible for higher prevalence of cardiovascular diseases in patients with chronic kidney disease. Inflammatory process of unknown aetiology belongs to the so-called non-traditional risk factors in development of cardiovascular system diseases. It is thought that this process is responsible for adverse remodelling of atherosclerosis plaque and its instability which causes plaque rupture and as a result a coronary syndrome occurrence. Important inflammatory mediators, which take part in pathogenesis of ACS, are acute phase proteins such as: C-reactive protein, adhesion molecules VCAM-1, ICAM-1, selectins, plasma amyloid A, metalloproteinases, interleukins-1 and -6, tumour necrosis factor-a and vascular endothelial growth factor.     

急性冠状动脉综合征患者单核细胞核因子-κB活性变化与可溶性细胞间黏附分子-1的关系

目的　观察不同类型冠心病患者外周血单核细胞核因子 κB (NF κB)活性水平变化及其与血浆可溶性细胞间黏附分子 1(sICAM 1)的关系 ,以探讨识别与预测急性冠状动脉综合征 (ACS)的炎性指标。方法　采用夹心酶联免疫吸附法和免疫组织化学染色测定。 6 0例冠心病患者 [30例ACS ,30例稳定性冠心病 (SCHD) ]及 30例对照组的血浆sICAM 1浓度和外周血单核细胞NF κB活性。同时采用直线相关分析法分析NF κB活性与sICAM 1浓度相关性。结果　ACS组NF κB活性和sICAM 1浓度显著高于SCHD组和对照组 (P <0 .0 1) ,而且NF κB活性与sICAM 1浓度呈显著正相关。但SCHD组NF κB活性和sICAM 1浓度与对照组比较 ,差异无显著性意义。结论　ACS组NF κB活性和sICAM 1浓度升高 ,提示其可能与ACS的发生有关 ,血浆sICAM 1浓度水平升高可能是通过NF κB调节途径而实现。     

In-hospital initiation of statin therapy in acute coronary syndromes: maximizing the early and long-term benefits

Patients with acute coronary syndrome (ACS) are at high risk for recurrent coronary events, sudden death, and all-cause mortality. Conventional revascularization therapies reduce the risk of further ischemia but do not affect the underlying atherosclerotic disease. Statins have a proven record in the secondary prevention of coronary heart disease. Furthermore, statins have been shown to exert varying degrees of pleiotropic effects, which may stabilize vulnerable atherosclerotic plaques. A compelling body of evidence from randomized controlled trials demonstrates that high-dose, potent statin therapy initiated immediately after an acute coronary event can significantly reduce early as well as longer-term morbidity and mortality. Furthermore, high-dose, potent statin therapy displays a reasonable safety profile. National guidelines now recommend that in patients with ACS, statin therapy should be initiated in hospital prior to discharge, irrespective of baseline low-density lipoprotein cholesterol levels, to improve clinical outcomes. Every effort should be made to ensure all eligible patients with ACS are initiated and maintained on statin therapy.     

血尿酸升高及炎症反应在冠心病发生中的作用

目的 探讨血清尿酸(UA)升高及炎症反应在冠心病(CHD)发生中的作用.方法 用化学比色法、ELISA法分别检测急性冠脉综合征(ACS组)、稳定型心绞痛(SAP组)患者和健康对照组的血清UA和高敏C反应蛋白(hsCRP),并进行比较及相关分析.结果 ACS组、SAP组血清UA和hsCRP均高于对照组(P均<0.05);ACS组hsCRP高于SAP组(P<0.05);SAP和ACS组血清UA与hsCRP均呈正相关(r分别为0.662、0.802,P均<0.05).SAP组、ACS组高尿酸血症者hsCRP均高于UA正常者(P均<0.05).结论 血清UA升高可能是CHD的一个危险因素,通过促进炎症反应导致CHD发生发展.     

Management of acute coronary syndrome in the context of coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) is still developing worldwide. The prognosis of the disease will become worse and mortality will be even higher when it is combined with cardiovascular disease. Furthermore, COVID-19 is highly infectious and requires strict isolation measures. For acute coronary syndromes (ACS), a common cardiovascular disease, infection may aggravate the occurrence and development of ACS, making the management of more difficult. It will be an enormous challenge for clinical practice to deal with ACS in this setting of COVID-19.Aim to reduce the mortality of ACS patients during the epidemic of COVID-19 by standardizing procedures as much as possible.Pubmed and other relevant databases were searched to retrieve articles on COVID-19 and articles on ACS management strategies during previous influenza epidemics. The data was described and synthesized to summarize the diagnosis and management strategy of ACS, the preparation of catheter laboratory, and the protection of the medical staff in the context of COVID-19. Ethical approval is not required in this study, because it is a review with no recourse to patient identifiable information.Standardized diagnosis and treatment advice can help reduce the mortality of COVID-19 patients with ACS. In the absence of contraindications, the third generation of thrombolytic drugs should be the first choice for thrombolytic treatment in the isolation ward. For patients who have to receive PCI, this article provides detailed protective measures to avoid nosocomial infection.     

C-反应蛋白与急性冠脉综合征及其干预研究进展

炎症在急性冠脉综合征的发病机制中发挥重要作用,C-反应蛋白不仅是冠状动脉事件的标志物,也是冠状动脉事件的独立致病因素,因此有效的降低血浆C-反应蛋白浓度将是急性冠脉综合征治疗与预防的又一手段。     

他汀类药物的作用多向性效应及其临床应用

他汀类药物能显著降低总胆固醇、低密度脂蛋白胆固醇和升高高密度脂蛋白胆固醇,在急性冠状动脉综合征的治疗中发挥着稳定粥样硬化斑块、降低急性冠状动脉综合征患者急性期病死率的作用。近年来的临床和实验研究证实,他汀类具有作用多向性效应,可以防治20余种疾病,其中多数与调脂作用无关。