女性ST段抬高型心肌梗死合并多支血管病变行直接经皮冠脉介入术预后分析北大核心CSCD

目的观察女性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)合并多支病变(multivessel disease, MVD)行直接经皮冠状动脉介入术(percutaneous coronary intervention, PCI)患者的临床特征, 并探究影响女性预后的因素。方法本研究为回顾性队列研究, 入选2005-2015年以STEMI合并MVD就诊于本院并且在症状发作24 h内成功完成直接PCI的患者1 033例, 其中女性196例。收集患者基线、PCI术资料, 随访采取集中电话和病例随访。通过Kaplan-Meier法绘制生存曲线。利用Cox回归模型筛选不同性别STEMI多支病变患者影响预后的因素。结果与男性患者相比, 女性发病年龄显著较高, 而吸烟史、冠心病家族史、支架植入史的比例显著较低, 其发病到行PCI术的时间显著延长, 术中发生慢血流/无复流的比例显著较高。平均随访时间为4年, 女性的主要心血管不良事件发生率始终高于男性。影响女性患者预后的主要因素为Killip心功能分级Ⅱ~Ⅳ级(HR=1.804, 95%CI 1.060~3.071,P<0.05);而狭窄程度超过50%的病变数(HR=1.808, 95%CI:1.123~2.912,P<0.01), 为男女共同的危险因素。结论与男性相比, STEMI合并MVD行直接PCI的女性患者, 救治延迟显著, 主要心血管不良事件发生率较高, 心功能不全是影响女性患者不良预后的主要因素。     

急性心肌梗死溶栓再通后心力衰竭的危险因素

目的：探讨急性心肌梗死溶栓再通后住院期间发生心力衰竭的危险因素。方法选取我院住院的急性ST 段抬高型心肌梗死(STEMI)溶栓再通后的患者130例,根据住院期间是否发生心力衰竭,分为心力衰竭组31例和非心力衰竭组99例。比较两组患者一般临床特征、危险因素、血压、白细胞计数(WBC)、肌钙蛋白(cTnI)、生化指标、心肌梗死面积(MIA)、左心室射血分数(LVEF)、B 型脑钠肽(BNP)等相关指标,分析 STEMI 患者溶栓再通后住院期间发生心力衰竭的因素。结果2组间年龄、糖尿病史、发病到血管再通时间、收缩压、前壁心肌梗死及广泛前壁心肌梗死比例、MIA、血糖、cTnI、WBC、γ-谷氨酰转肽酶(GGT)、LVEF、BNP 比较,差异具有统计学意义(P <0.05)。发病到血管再通时间延长(OR =4.402,95% CI =1.565~12.382)、收缩压升高(OR =1.095,95% CI =1.019~1.175)、高血糖(OR =2.132,95% CI =1.127~4.033)、高 cTnI(OR =1.352,95% CI =1.031~1.773)、GGT 升高(OR =1.182,95% CI =1.204~1.365)、高 MIA(OR =1.656,95% CI =1.162~2.360)是 STEMI 溶栓再通患者住院期间发生心力衰竭的危险因素。结论发病到血管再通时间延长、收缩压升高、高血糖、高 cTnI、GGT 升高及高MIA 是 STEMI 溶栓再通患者住院期间发生心力衰竭的危险因素。     

ST段抬高型心肌梗死患者入院血糖与外周血单个核细胞TLR4表达和活性的关系

目的研究ST段抬高型心肌梗死(STEMI)患者入院血糖与外周血单个核细胞(PBMCs)Toll样受体4(TLR4)表达和活性的关系,探讨入院血糖影响STEMI患者住院临床预后的可能机制。方法 142例STEMI患者纳入本研究,检测入院血糖、PBMCs TLR4及白细胞介素-6(IL-6)m RNA表达、血IL-6及肿瘤坏死因子α(TNF-α)水平。根据入院血糖水平分为高血糖组(入院血糖≥7.8 mmol/L)和正常血糖组(入院血糖<7.8 mmol/L)。比较两组患者临床特征、主要心脏不良事件、PBMCs TLR4表达和活性的差异,分析入院血糖与PBMCs TLR4表达和活性的相关性。结果高血糖组年龄、糖尿病史、体质指数、心率、白细胞计数、入院血糖、肌钙蛋白I、肌酸激酶、肌酸激酶同工酶、血IL-6和TNF-α显著高于正常血糖组(P<0.05),舒张压和左心室射血分数显著低于正常血糖组(P<0.05)。高血糖组住院期间恶性心律失常、心力衰竭和死亡等主要心脏不良事件的发生率显著高于正常血糖组(P<0.05)。高血糖组PBMCs TLR4 m RNA及IL-6 m RNA表达水平显著高于正常血糖组(3.34±0.68 vs.1.68±0.55,P<0.05;2.89±0.47 vs.1.62±0.57,P<0.05)。Logistic回归分析显示,在所有入选的STEMI患者中,入院血糖是恶性心律失常、心力衰竭和死亡等主要心脏不良事件的独立危险因素(OR=1.976,95%CI:1.445~2.703,P<0.05;OR=2.117,95%CI:1.483~3.023,P<0.05;OR=2.317,95%CI:1.421~3.778,P<0.05)。Pearson相关性分析显示,入院血糖与PBMCs TLR4 m RNA、IL-6 m RNA表达水平呈正相关(r=0.577,0.527,P均<0.05)。结论急性STEMI入院高血糖患者住院期间主要心脏不良事件的发生率显著增加,急性STEMI患者入院血糖与PBMCs TLR4表达和活性显著正相关,急性STEMI患者入院高血糖可能通过增加单核细胞TLR4表达和活性导致心脏不良事件的发生。     

住院患者社区获得性与医院获得性急性肾损伤临床特征及预后分析

目的探讨住院患者发生社区获得性急性肾损伤(community-acquired acute kidney injury, CA-AKI)、医院获得性急性肾损伤(hospital-acquired acute kidney injury, HA-AKI)的临床特征及预后的影响因素。方法住院发生急性肾损伤(acute kidney injury, AKI)患者933例,其中510例HA-AKI为HA-AKI组、423例CA-AKI为CA-AKI组,比较2组临床资料,多因素logistic回归分析CA-AKI、HA-AKI患者住院期间死亡的危险因素。结果 HA-AKI组血肌酐峰值[(162.2±119.9)μmol/L]、入院时AKI分期3期比率(43.9%)、转入ICU比率(7.3%)、有高血压史比率(52.4%)、住院期间使用利尿剂比率(48.6%)较CA-AKI组[(145.1±98.4)μmol/L、36.5%、4.0%、41.1%、40.4%]高,住院时间[(15.4±7.3)d]较CA-AKI组[(14.1±7.9)d]长,年龄[(62.3±16.0)岁]较CA-AKI组[(64.5±16.7)岁]小,入院血肌酐[(99.3±59.6)μmol/L]、估算肾小球滤过率(estimated glomerular filtration rate, eGFR)[(80.2±34.6) mL/(min·1.73 m~2)]较CA-AKI组[(137.7±94.9)μmol/L、(93.7±29.3)mL/(min·1.73 m~2)]低(P0.05),住院期间病死率(15.1%)较CA-AKI组高(6.1%)(P0.05);HA-AKI组死亡患者基础血肌酐[(160.4±69.7)μmol/L]、血肌酐峰值[(231.7±170.0)μmol/L]、转入ICU比率(37.7%)、入院时AKI分期1期比率(75.3%)、住院期间使用利尿剂比率(62.3%)高于CA-AKI组死亡患者[(107.6±67.3)μmol/L、(154.0±98.4)μmol/L、15.4%、46.2%、26.9%],eGFR[(77.5±28.4) mL/(min·1.73 m~2)]低于CA-AKI组死亡患者[(95.1±24.4) mL/(min·1.73 m~2)],住院时间[(7.1±6.1)d]较CA-AKI组死亡患者[(13.8±8.5)d]短(P0.05);多因素logistic回归分析结果显示,转入ICU(OR=5.96,95%CI:1.74～20.47,P=0.005)、有脑血管病史(OR=2.48,95%CI:1.07～5.72,P=0.034)是CA-AKI患者住院期间死亡的危险因素,转入ICU(OR=5.84,95%CI:2.73～12.52,P0.001)、有脑血管病史(OR=2.32,95%CI:1.33～4.04,P=0.003)、住院期间使用利尿剂(OR=2.18, 95%CI:1.27～3.75,P=0.005)、入院时AKI分期3期(OR=5.21, 95%CI:1.86～14.59,P=0.002)是HA-AKI患者住院期间死亡的危险因素。结论 HA-AKI、CA-AKI是住院患者常见的并发症,HA-AKI病情相对较重,病死率高,转入ICU、有脑血管病史是二者住院期间死亡的共同危险因素,住院期间使用利尿剂、AKI分期3期与HA-AKI预后不良有关。     

行肠外营养治疗的ICU重症患者发生抗生素相关性腹泻的影响因素分析

目的分析行肠外营养治疗的ICU重症患者的临床资料,探讨其发生抗生素相关性腹泻(antibiotic-associated diarrhea,AAD)的影响因素。方法行肠外营养治疗的ICU重症患者177例,发生AAD者50例为AAD组,未发生AAD者127例为非AAD组。比较2组年龄,性别比例,合并高血压、糖尿病比率,ICU住院时间,入住ICU时白蛋白水平,急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)及益生菌、质子泵抑制剂、抗生素使用情况;多因素logistic回归分析行肠外营养治疗的ICU重症患者发生AAD的影响因素。结果177例患者AAD发生率为28.25%。AAD组年龄[(56.80±20.41)岁]大于非AAD组[(47.12±19.30)岁](P<0.05),ICU住院时间[(17.82±12.15)d]、抗生素使用时间[(13.08±8.84)d]长于非AAD组[(9.83±7.11)、(7.92±4.83)d](P<0.05),联合使用抗生素(72.00%)及联合使用3种抗生素比率(46.00%),加酶抑制剂类、抗真菌类、恶唑烷酮类及喹诺酮类抗生素使用比率(80.00%、58.00%、26.00%、28.00%)均高于非AAD组(43.31%、19.69%、62.99%、24.41%、12.60%、11.02%)(P<0.05)。多因素logistic回归分析结果显示,年龄(OR=1.020,95%CI:1.000~1.041,P=0.048)、ICU住院时间(OR=1.058,95%CI:1.007~1.113,P=0.026)、抗生素使用时间(OR=1.124,95%CI:1.062~1.189,P<0.001)、联合使用3种抗生素(OR=3.366,95%CI:1.655~6.848,P=0.001)、使用加酶抑制剂类抗生素(OR=2.350,95%CI:1.076~5.131,P=0.032)是行肠外营养治疗的重症患者发生AAD的影响因素。结论年龄、ICU住院时间、抗生素使用时间、联合使用3种抗生素与行肠外营养治疗的ICU重症患者发生AAD有关。     

上消化道内镜治疗致医源性食管贲门黏膜撕裂症的影响因素

目的探讨上消化道内镜治疗导致医源性食管贲门黏膜撕裂症(Mallory-Weiss tear,MWT)发生的影响因素。方法上消化道内镜治疗后发生医源性MWT患者50例为MWT组,未发生医源性MWT患者100例为对照组,比较2组临床特征,多因素logistic回归分析上消化道内镜治疗后发生医源性MWT的影响因素。结果MWT组年龄[(66±13)岁]较对照组[(55±14)岁]大(P<0.05),手术时间[70.00(30.75,112.00)min]较对照组[14.00(10.00,25.75)min]长(P<0.05),手术部位位于胃窦/十二指肠比率(66.0%)、行内镜黏膜下剥离术及经内镜逆行性胰胆管造影术比率(34.0%、44.0%)较对照组(42.0%、9.0%、18.0%)高(P<0.05);MWT组体质量指数[(23.58±2.02)kg/m^2],男性比率(56.0%),有糖尿病、反流性食管炎/贲门炎、腹部手术史比率(6.0%、12.0%、28.0%)与对照组[(24.13±3.19)kg/m^2、47.0%、10.0%、11.0%、26.0%)比较差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,年龄(OR=3.011,95%CI:1.329~6.818,P=0.008)、手术时间(OR=1.031,95%CI:1.012~1.050,P=0.001)、手术部位位于胃窦十二指肠(OR=29.194,95%CI:2.633~323.655,P=0.006)是发生医源性MWT的影响因素。结论年龄、手术部位、手术时间是医源性MWT发生的影响因素。     

急性脑梗死重组组织型纤溶酶原激活剂溶栓治疗出血转化的危险因素分析

目的:探讨急性脑梗死患者静脉应用重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后出血转化(HT)的危险因素。方法:回顾性分析2017-01—2018-12期间收治的245例接受rt-PA静脉溶栓治疗的急性脑梗死患者的临床资料,根据溶栓后是否发生出血转化分为HT组与非HT组(NHT组)。收集两组患者一般资料、发病至治疗时间(OTT)、溶栓前美国国立卫生院脑卒中量表(NIHSS)评分、实验室检查指标、影像学特点等资料。应用Logistic回归分析溶栓后出血转化的危险因素。结果:245例接受rt-PA溶栓的急性脑梗死患者发生HT的38例,占15.51%。单因素分析显示,年龄、吸烟史、溶栓前收缩压、溶栓前血糖、糖尿病史、心房颤动史、溶栓前NIHSS评分、OTT、血尿酸、脑白质疏松是急性脑梗死溶栓后HT的影响因素(P0.05);多因素Logistic回归分析结果显示,糖尿病(OR=0.737,95%CI:0.765～1.048)、溶栓前NIHSS评分(OR=0.590,95%CI:0.428～0.814)、OTT(OR=0.351,95%CI:0.530～1.185)、血尿酸(OR=0.954,95%CI:0.928～0.980)、溶栓前收缩压(OR=0.819,95%CI:0.737～0.910)、脑白质疏松(OR=0.459,95%CI:0.865～0.912)是急性脑梗死溶栓后HT的独立危险因素。结论:糖尿病、溶栓前NIHSS评分、OTT、血尿酸、溶栓前收缩压、脑白质疏松是急性脑梗死溶栓后HT的独立危险因素。因此,临床上针对此类患者进行rt-PA静脉溶栓治疗时应谨慎,避免不良事件的发生。     

肺结核合并艾滋病患者抗结核治疗的转归及危险因素分析

目的分析肺结核合并艾滋病患者抗结核治疗的转归,探讨导致不良转归的危险因素。方法对117例接受抗结核治疗的肺结核合并艾滋病患者的转归情况进行调查,分析体质量、年龄、CD4+T淋巴细胞计数、抗病毒治疗接受情况、HIV感染时间、HIV感染途径、肺结核类型、其他机会感染等对患者不良转归的影响。结果 117例患者死亡21例为不良转归组,96例为未死亡组,病死率17.9%;不良转归组患者开始抗结核治疗时CD4+T淋巴细胞计数[(89.7±55.2)个/μL]、实施抗病毒治疗率(52.4%)均低于未死亡组[(173.5±82.4)个/μL、91.7%],经静脉吸毒感染HIV(66.7%)、涂阳肺结核比率(57.1%)高于未死亡组(39.6%、32.3%)(P0.05);未接受抗病毒治疗(OR=12.391,95%CI:2.552~35.871,P=0.000)、静脉吸毒感染HIV(OR=0.259,95%CI:0.105~0.551,P=0.001)、涂阳肺结核(OR=0.412,95%CI:0.182~0.805,P=0.000是不良预后的独立危险因素。结论肺结核合并艾滋病患者抗结核治疗期间病死率高,未接受抗病毒治疗、静脉吸毒感染HIV及涂阳肺结核是其不良预后的危险因素。     

不同性别良性阵发性位置性眩晕患者临床特征分析

目的:比较不同性别良性阵发性位置性眩晕(BPPV)患者的临床特征及复发危险因素。方法:回顾性分析424例BPPV患者的临床资料,按性别进行分组比较不同性别患者临床特征,再按是否复发分为亚组,比较不同性别患者复发的危险因素。结果:与女性组比较,男性组BPPV患者发病年龄较大,吸烟和饮酒比例较高,合并骨质疏松比例较低(均P0.05)。男性BPPV患者手法复位后1年内复发率为20.2%,显著低于女性组31.5%(P=0.033)。年龄、家族史、糖尿病、后循环缺血和骨质疏松与男性BPPV患者复发相关(均P0.05);年龄是男性BPPV患者手法复位后1年内复发的危险因素(OR=1.331,95%CI 1.015～4.072,P=0.002)。女性BPPV患者复发亚组的年龄更大,合并高血压、糖尿病、后循环缺血和骨质疏松比例更高(均P0.05);年龄、糖尿病和骨质疏松均是女性BPPV患者手法复位后1年内复发的危险因素(OR=2.040,95%CI 1.314～5.680,P=0.000;OR=1.375,95%CI 1.072～4.044,P=0.007;OR=1.216,95%CI 1.081～5.087,P=0.011)。结论:不同性别BPPV患者临床特征和复发的危险因素均存在差异。     

ST段抬高型心肌梗死直接经皮冠状动脉介入术治疗预后危险因素及危险分层

目的探讨行直接经皮冠状动脉介入术(primary percutaneous coronary intervention, pPCI)治疗的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者院内主要心血管不良事件(major adverse cardiovascular events, MACEs)发生的危险因素并进行危险分层。方法行pPCI治疗的STEMI患者128例,依据术后10 d是否发生MACEs分为MACEs组62例,非MACEs组66例。记录患者一般资料,多因素logistic回归分析MACEs发生的危险因素,并根据OR值对危险因素进行危险分层。结果 MACEs组年龄、心率、ST段抬高总幅度、平均ST段抬高幅度,以及饮酒、下壁心肌梗死、Killip分级Ⅱ～Ⅲ级比率与非MACEs组比较差异均有统计学意义(P0.05),体质量、左室射血分数等与非MACEs组比较差异均无统计学意义(P0.05);年龄60岁(OR=4.45,95%CI:1.65～12.04,P=0.003),入院时心率≤67次/min(OR=3.47, 95%CI:1.25～9.63,P=0.017)、ST段抬高总幅度≥1.15 mV (OR=10.08,95%CI:2.64～38.53,P=0.001)、下壁心肌梗死(OR=7.78,95%CI:2.11～28.69,P=0.002)、Killip分级Ⅱ级(OR=4.21, 95%CI:2.96～6.32,P0.001)、Killip分级Ⅲ级(OR=8.38, 95%CI:4.56～13.53,P0.001)是院内发生MACEs的危险因素;危险分层结果显示,高风险组院内MACEs发生率(86.54%)高于低风险组(22.37%)(P0.05)。结论高龄(60岁)、入院时心率(≤67次/min)、Killip分级Ⅱ～Ⅲ级、下壁心肌梗死及ST段抬高总幅度≥1.15 mV是STEMI患者行pPCI治疗后发生院内MACEs的危险因素,根据危险因素对患者进行危险分层有助于识别危重患者、及时行pPCI治疗。     

Effect of COVID-19 outbreak on the treatment time of patients with acute ST-segment elevation myocardial infarction

ObjectiveTo explore the effect of COVID-19 outbreak on the treatment time of patients with ST-segment elevation myocardial infarction (STEMI) in Hangzhou, China.MethodsWe 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.ResultsThe 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).ConclusionThe 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.     

急性ST段抬高型心肌梗死合并血糖代谢异常患者预后分析

目的:总结急性ST段抬高型心肌梗死(STEMI)合并血糖代谢异常(2型糖尿病或就诊血糖升高)患者的预后。方法:回顾性分析2010年1月-2013年9月我科确诊STEMI患者413例的临床资料,比较血糖正常组(A组)与就诊血糖升高组(B组)、2型糖尿病组(C组)的预后。结果:(B+C)组住院期间死亡率明显高于A组(24.7%vs.9.4%,P0.05),C组住院期间再发心肌梗死率明显高于B组和A组(3.9%vs.0%vs.0.7%,P0.05),C组、B组与A组比较,再发心绞痛率(23.4%vs.31.0%vs.14.7%,P0.05)、住院期间心力衰竭率(41.6%vs.50.0%vs.22.1%,P0.05)、住院期间MACE(58.4%vs.65.5%vs.33.4%,P0.05)及一年全因死亡率(34.2%vs.31.4%vs.16.7%,P0.05)发生率更高。结论 :STEMI合并血糖代谢异常的预后差于血糖正常组。     

Predictive value of elevated cystatin C in patients undergoing primary angioplasty for ST-elevation myocardial infarction

Objectives

The prognostic value of cystatin C (CysC) has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the prognostic value of CysC in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

Methods

We prospectively enrolled 475 consecutive STEMI patients (mean age 55.6 ± 12.4 years, 380 male, 95 female) undergoing primary PCI. The study population was divided into tertiles based on admission CysC values. The high CysC group (n = 159) was defined as a value in the third tertile (> 1.12 mg/L), and the low CysC group (n = 316) included those patients with a value in the lower two tertiles (≤ 1.12 mg/L). Clinical characteristics and in-hospital and one-month outcomes of primary PCI were analyzed.

Results

The patients of the high CysC group were older (mean age 62.8 ± 13.1 vs. 52.3±10.5, P < .001). Higher in-hospital and 1-month cardiovascular mortality rates were observed in the high CysC group (9.4% vs. 1.6%, P < .001 and 14.5% vs. 2.2%, P < .001, respectively). In Cox multivariate analysis; a high admission CysC value (> 1.12 mg/L) was found to be a powerful independent predictor of one-month cardiovascular mortality (odds ratio, 5.3; 95% confidence interval, 1.25-22.38; P = .02).

Conclusions

These results suggest that a high admission CysC level was associated with increased in-hospital and one-month cardiovascular mortality in patients with STEMI undergoing primary PCI.     

Clinical Characteristics,Management Strategies and Outcomes of Acute Myocardial Infarction Patients With Prior Coronary Artery Bypass Grafting

ObjectiveTo investigate the management strategies, temporal trends, and clinical outcomes of patients with a history of coronary artery bypass graft (CABG) surgery and presenting with acute myocardial infarction (MI).Patients and MethodsWe undertook a retrospective cohort study using the National Inpatient Sample database from the United States (January 2004–September 2015), identified all inpatient MI admissions (7,250,768 records) and stratified according to history of CABG (group 1, CABG-naive [94%]; group 2, prior CABG [6%]).ResultsPatients in group 2 were older, less likely to be female, had more comorbidities, and were more likely to present with non-ST-elevation myocardial infarction compared with group 1. More patients underwent coronary angiography (68% vs 48%) and percutaneous coronary intervention (PCI) (44% vs 26%) in group 1 compared with group 2. Following multivariable logistic regression analyses, the adjusted odd ratio (OR) of in-hospital major adverse cardiovascular and cerebrovascular events (OR, 0.98; 95% CI, 0.95 to 1.005; P=.11), all-cause mortality (OR, 1; 95% CI, 0.98 to 1.04; P=.6) and major bleeding (OR, 0.99; 95% CI, 0.94 to 1.03; P=.54) were similar to group 1. Lower adjusted odds of in-hospital major adverse cardiovascular and cerebrovascular events (OR, 0.64; 95% CI, 0.57 to 0.72; P<.001), all-cause mortality (OR, 0.45; 95% CI, 0.38 to 0.53; P<.001), and acute ischemic stroke (OR, 0.71; 95% CI, 0.59 to 0.86; P<.001) were observed in group 2 patients who underwent PCI compared with those managed medically without any increased risk of major bleeding (OR, 1.08; 95% CI, 0.94 to 1.23; P=.26).ConclusionsIn this national cohort, MI patients with prior-CABG had a higher risk profile, but similar in-hospital adverse outcomes compared with CABG-naive patients. Prior-CABG patients who received PCI had better in-hospital clinical outcomes compared to those who received medical management.     

中性粒细胞与淋巴细胞比值联合GRACE评分对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值

目的 探讨中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)联合全球急性冠状动脉事件注册(global registry of acute coronary events,GRACE)评分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者接受直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)术治疗后发生院内主要不良心血管事件(major adverse cardiovascular events,MACE)的预测价值。方法 纳入2018年9月1日-2019年12月31日就诊于河北省人民医院心血管内科行直接PCI治疗的急性STEMI患者275例。根据PCI术后是否发生院内MACE(包括全因死亡、心源性休克、院内再次血运重建、恶性心律失常及心脏骤停),分为MACE组(35例)和非MACE组(240例)。收集两组临床资料,分析STEMI患者PCI术后发生院内MACE的独立危险因素,并绘制受试者工作特征(receiver operating characteristic, ROC)曲线分析NLR、GRACE评分及二者联合对急性STEMI患者PCI术后发生院内MACE的预测价值。结果 MACE组年龄、GRACE评分、CRUSADE评分及NLR均高于非MACE组,估算的肾小球滤过率低于非MACE组(均P<0.05)。多因素Logistic回归分析提示,GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素(均P<0.05)。ROC曲线提示,GRACE评分、NLR对急性STEMI患者PCI术后发生院内MACE有一定预测能力,但两者联合的曲线下面积更大,可更好地预测急性STEMI患者PCI术后是否发生院内MACE。结论 GRACE评分、NLR是急性STEMI患者PCI术后发生院内MACE的独立危险因素,两者联合对急性STEMI患者PCI术后发生院内MACE具有较好的预测价值。     

Serum uric acid in patients with acute ST-elevation myocardial infarction

BACKGROUND:

Few studies investigated serum uric acid levels in patients with acute Stelevation myocardial infarction (STEMI). The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction (STEMI).

METHODS:

Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010. The level of serum lipid, echocardiographic data and in-hospital major adverse cardiovascular events (MACE) in patients with hyperuricemia (n=119) were compared with those in patients without hyperuricemia (n=383). The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed. All data were analyzed with SPSS version 17.0 software for Student’s t test, the Chi-square test and Pearson’s correlation coefficient analysis.

RESULTS:

Serum uric acid level was positively correlated with serum triglyceride level. Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients (43.7% vs. 33.7%, P=0.047), and serum triglyceride level was significantly higher in hyperuricemia patients (2.11±1.24 vs. 1.78±1.38, P=0.014). But no significant association was observed between serum uric acid level and one or more diseased vessels (P>0.05). Left ventricular end-diastolic diameter (LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients (53.52±6.19 vs. 52.18±4.89, P=0.041). The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients (36.4% vs. 15.1%, P<0.001; 68.2% vs. 55.8%, P=0.023). Also, hyperuricemia patients were more likely to have in-hospital MACE (P<0.05).

CONCLUSIONS:

Serum uric acid level is positively correlated with serum triglyceride level, but not with the severity of coronary artery disease. Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in hospital MACE.KEY WORDS: Acute ST-elevation myocardial infarction, Serum uric acid, Triglyceride, Coronary angiography, Echocardiography, Left ventricular systolic dysfunction, Left ventricular diastolic dysfunction, Major adverse cardiovascular events     

性别对急性ST段抬高心肌梗死直接经皮冠状动脉介入治疗预后的影响

目的 探讨性别对急性ST段抬高心肌梗死(STEMI)直接经皮冠状动脉介入(PCI)治疗预后的影响.方法 分析比较478例男性和101例女性急性ST段抬高心肌梗死患者的危险因素、冠状动脉造影特点和预后情况.结果 不同年龄段STEMI发病率的性别差异有统计学意叉(P<0.01),女性发病较男性晚10年以上,≥71岁女性发病率升高更明显;女性多合并原发性高血压、2型糖尿病,且2型糖尿病明显高于男性(P<0.01);女性多支病变明显高于男性(P<0.01).女性院内病死率、假性动脉瘤/血肿发生率明显高于男性(P<0.05,P<0.01).结论 直接PCI治疗STEMI女性患者的住院病死率及穿刺血管并发症发生率较男性高.     

血清脂滴蛋白-5检测对急性ST段抬高型心肌梗死病变预后的评估价值

目的研究血清脂滴蛋白-5检测对急性ST段抬高型心肌梗死(STEMI)患者预后的评估价值。方法采用回顾性分析方法,研究对象为2018年6月至2019年6月青海省心脑血管病专科医院收治的64例STEMI患者,所有患者均于入院次日检测血清脂滴蛋白-5水平,并根据脂滴蛋白-5表达水平分为低表达组(<3.12μg/L)和高表达组(>3.12μg/L),各32例。比较2组患者冠状动脉病变程度,比较1年内死亡与存活患者的血清脂滴蛋白-5水平,随访1年内心血管不良事件发生率、病死率。结果低表达组3只血管病变率(33.33%)明显高于高表达组(4.17%),差异有统计学意义(P<0.05)。1年内死亡患者的血清脂滴蛋白-5表达水平[(1.69±0.32)μg/L]明显低于存活患者[(4.07±0.81)μg/L],差异有统计学意义(P<0.05)。低表达组1周、1个月、6个月及1年的病死率(15.63%、18.75%、25.00%、37.50%)明显高于高表达组(0、3.13%、6.25%、12.50%),差异均有统计学意义(P<0.05)。低表达组1周、1个月、6个月及1年的心血管不良事件发生率(21.88%、31.25%、40.63%、56.25%)明显高于高表达组(3.13%、6.25%、9.38%、15.63%),差异均有统计学意义(P<0.05)。结论血清脂滴蛋白-5表达水平与STEMI患者的近远期预后及冠状动脉病变程度显著相关,血清脂滴蛋白-5表达水平越低,预后越差。     

昼夜节律对急性ST段抬高型心肌梗死患者院内心血管事件的影响

目的研究昼夜节律对急性ST段抬高型心肌梗死（STEMI）患者院内心血管事件发生率的影响。 方法收集2016年1月至2017年12月就诊的STEMI患者212例,根据发病时间将患者分为上午组（84例）、下午组（64例）及夜间组（64例）,比较三组患者住院期间的主要心血管不良事件（MACE）和次要心血管不良事件发生情况,并采用Logistic回归模型对STEMI患者住院期间MACE的影响因素进行分析。 结果夜间组MACE[20.0%（13/64）、6.0%（5/84）、7.8%（5/64）]及恶性心律失常[18.8%（12/64）、2.4%（2/84）、4.7%（3/64）]发生率均显著高于上午组及下午组（P均<0.017）,而上午组及下午组之间比较,差异均无统计学意义（P均>0.017）。而三组患者间心功能不全、心律失常和出血发生率比较,差异均无统计学意义（χ²=0.696、1.601、2.555,P=0.706、0.449、0.279）。多因素Logistic结果显示夜间发病是STEMI患者住院期间发生MACE的危险因素[OR=3.736,95%CI（1.172,11.902）,P=0.028]。 结论夜间发病会增加STEMI患者院内发生MACE的风险。     

男女性别差异对于行急诊经皮冠状动脉成形术治疗患者预后影响分析

目的探讨在药物涂层支架时代,行急诊PCI治疗的急性ST段抬高心肌梗死(STEMI)患者中,不同性别患者的PCI预后差异。方法连续纳入687例行急诊PCI治疗的STEMI患者,其中男572例,女115例。比较不同性别患者的基线特征、手术结局及临床预后。结果女性患者发病的平均年龄大于男性,合并多支病变的比例也要高于男性。女性患者院内(3.8%vs.4.3%,P=0.792)及1年期(6.6%vs.7.8%,P=0.647)的主要不良心血管事件率与男性无统计学差异。但女性院内的大出血事件(11.3%vs.5.4%,P=0.019)及穿刺并发症(9.6%vs.4.9%,P=0.048)要高于男性。女性患者一年随访时的再发心绞痛事件率也要高于男性(10.4%vs.3.9%,P=0.003)。结论在药物涂层支架时代,对于行急诊PCI治疗的STEMI患者,不同性别间的近期及1年期的主要临床终点预后相似。但女性的出血及穿刺点并发症风险更高。合理的避免出血是提升女性PCI质量的首要目标。