Impact of patients’ symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction

Background Delay in seeking medical care in patients with acute myocardial infarction （AMI） is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI. Methods Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction （STEMI） admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review. Results The median （25%, 75%） prehospital delay was 140 （75, 300） minutes. Only 264 （33.0%） arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain （71.4%）, radiating arm or shoulder pain （68.7%）, shortness of breath or dyspnea （65.5%）, and loss of consciousness （52.1%）. The most common symptoms experienced were central or left chest pain （82.1%）, sweats （71.8%）, shortness of breath or dyspnea （43.7%）, nausea or vomiting （32.3%）, and radiating pain （29.4%）. A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport （86.5% vs. 52.9%, P 〈0.001） and had longer prehospital delays （medians, 180 vs. 120 minutes, P 〈0.001） compared to those who interpreted their symptoms as cardiac in origin. Conclusions Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emerqency medical service （EMS）.     

In-hospital delay to primary angioplasty for patients with ST- elevated myocardial infarction between cardiac specialized hospitals and non-specialized hospitals in Beijing, China

Background Evidence indicates that early reperfusion therapy in patients with ST-elevation myocardial infarction （STEMI） reduces complications. This study was undertaken to compare the in-hospital delay to primary percutaneous coronary intervention （PPCI） for patients with STEMI between specialized hospitals and non-specialized hospitals in Beijing, China. Methods Two specialized hospitals and fifteen non-specialized hospitals capable of performing PPCI were selected to participate in this study. A total of 308 patients, within 12 hours of the onset of symptoms and undergoing PPCI between November 1, 2005 and December 31, 2006 were enrolled. Data were collected by structured interview and review of medical records.Results The median in-hospital delay was 98 （interquartile range 105 to 180） minutes, and 16.9% of the patients were treated within 90 minutes. Total in-hospital delay and ECG-to-treatment decision-making time were longer in the non-specialized hospitals than in the cardiac specialized hospitals （147 minutes vs. 120 minutes, P〈0.001; 55 minutes vs. 45 minutes, P=0.035）. After controlling the confounding factors, the non-specialized hospitals were independently associated with an increased risk of being in the upper median of in-hospital delays.Conclusions There were substantial in-hospital delays between arrival at the hospital and the administration of PPCI for patients with STEMI in Beijing. Patients admitted to the cardiac specialized hospitals had a shorter in-hospital delay than those to the non-specialized hospitals because of a shorter time of ECG-to-treatment decision-making.     

Gender disparity in early death after ST-elevation myocardial infarction

Background Females with acute myocardial infarction （AMI） have a higher risk of adverse outcomes because of receiving less evidence-based medical care. Our aim was to investigate the gender disparity in early death after ST- elevation myocardial infarction （STEMI） in the current era. Methods A total of 1429 consecutive patients with STEMI in the Liaoning district were analyzed. We compared hospital care and cardiac event data by sex for in-patients with acute STEMI within 24 hours of symptom onset. Results In the emergency reperfusion group （n=754）, in-hospital mortality occurred in 4.2% of the males and 11.2% of the females （P=-0.001）. In the non-emergency reperfusion group （n=675）, in-hospital mortality occurred in 13.0% of the males and 22.9% of the females （P=-0.001）. Multivariate Logistic regression analysis revealed female sex as an independent risk factor of death for STEMI patients during hospitalization （OR=1.691, P=0.007）. After controlling for patients who died within 24 hr after admission, female sex was no longer an independent risk factor （OR=1.409, P=0.259）. Conclusion Female sex was an independent risk factor for in-hospital mortality of STEMI patients, which is explained by an excess of very early deaths.     

Factors influencing ambulance use in patients with ST-elevation myocardial infarction in Beijing, China

Background Emergency medical service plays a key role in the early recognition and treatment of ST-elevation myocardial infarction （STEMI）, but studies indicate that the patients experiencing STEMI symptoms often fail to call an ambulance as recommended. This study aimed to examine the current ambulance transport frequency and ascertain predictors and reasons for not choosing ambulance transportation by the patients with STEMI in Beijing. Methods A prospective, cross-sectional survey was conducted from January 1,2006 through until June 30, 2007 in two tertiary hospitals in Beijing and included consecutive patients with STEMI admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review. Results Of the 572 patients, only 172 （30.1%） used an ambulance, and the remaining 400 （69.9%） presented by self-transport. Multivariate analysis showed that age 〈65 years （OR： 1.220; 95% CI： 1.001-2.043）, lower education level （OR： 1.582; 95% CI： 1.003-2.512）, presence of pre-infarction angina （OR： 1.595; 95% CI： 1.086-2.347）, and attribution of symptoms to non-cardiac origin （OR： 1.519; 95% CI： 1.011-2.284） were independent predictors for not using an ambulance. However, history of coronary artery disease （CAD）, dyspnea, perceiving symptoms to be serious, and knowing the meaning of cardiopulmonary resuscitation appeared to be independent predictors of ambulance use. The main reasons for not using an ambulance were convenience and quickness of self-transport and the decreased severity of symptoms. Conclusions A large proportion of patients in Beijing do not call for an ambulance after onset of STEMI symptoms. Several factors including demographics, previous CAD, symptoms and cognitive factors of patients are associated with the ambulance use. The public should be educated that an ambulance is not merely a transportation modality and that it also provides rapid diagnosis and treatment.     

Factors associated with the extent of care-seeking delay for patients with acute myocardial infarction in Beijing

Background Prehospital delay remains one of the main causes of reduced benefit of reperfusion therapy for patients with acute myocardial infarction (AMI). The largest proportion of prehospital delay involves the interval between the onset of symptoms and the decision to seek medical treatment. The purpose of this study was to examine the factors associated with the extent of care-seeking delay in Beijing for patients with AMI. Methods A structured interview was conducted in 102 patients with AMI in eight hospitals in Beijing.Results The mean decision time in patients with AMI was (204±43) minutes, and prehospital delay time was (311±54) minutes. Only 34% of patients sought medical care within one hour and a further 36% of patients presented to one of the eight hospitals within two hours after onset. Educational level, atypical presentation of AMI, and family members at the site where AMI occurred were associated with longer delay time in seeking medical assistance (P<0.05, respectively), whereas the intensity of chest pain was inversely related to patients’ delay time (P<0.01). Patients who perceived their family relationship as good, attributed their symptoms to AMI origin, knew the time-dependent nature of reperfusion therapy, or used emergency medical service tended to seek medical care in a more rapid manner (P<0.05, respectively).Conclusions Patients with AMI in Beijing delay seeking medical care to a great extent. Health education to increase the level of awareness of the target population at increased risk of AMI, including patients and their family members, is probably beneficial to reduce patients’ care-seeking delay.     

Characteristics and Advantages of Traditional Chinese Medicine in the Treatment of Acute Myocardial Infarction

Objective: To obtain epidemiological data on Traditional Chinese Medicine (TCM) therapeutic status of acute myocardial infarction (AMI) and to determine TCM characteristics and advantages to improve the level of TCM prevention and treatment of AMI. Methods: Clinical epidemiology methods were used to register and survey the TCM therapeutic status of hospitalized AMI patients. In 2001, the Chinese Association of Integrative Medicine surveyed the therapeutic status of 3308 AMI patients hospitalized in 30 hospitals in Beijing and Shanghai from 2000-2001. The Beijing Collaborative Study Group on Therapeutic Status of Acute Myocardial Infarction (the Study Group) then conducted a 10-year-long register survey on hospitalized AMI patients in Third-grade A-Level TCM hospitals in Beijing. After 2002, the Study Group further surveyed the treatment conditions of AMI-hospitalized patients in 10 Second-grade A-Level TCM hospitals. The therapeutic status in 8 Third-grade A-Level Western medicine hospitals was surveyed in 2001 and 2005 as a control. In 2008, in cooperation with the China Association of Chinese Medicine, the Study Group further performed a survey at 26 Third-grade A-Level TCM hospitals nation-wide. Approximately 5000 cases were investigated to obtain authoritative data on the therapeutic status of AMI patients in TCM hospitals in China. Results: We found that Chinese herbal intravenous preparations may be beneficial in reducing the mortality of AMI. Major complications of AMI, such as heart failure and arrhythmia, were significantly less during the 10-year survey period. The mortality of hospitalized AMI patients showed a decline. TCM treatment was helpful for AMI patients in improving their quality of life. Ten-year dynamic monitoring showed that the ability to perform reperfusion and to use drugs appropriately, as well as an effort to carry out the Clinical Guidelines has made great progress in TCM hospitals. However, TCM hospitals still have some problems in treating AMI, including a lack of standardized TCM syndrome diagnosis, the need for syndrome differentiation and treatment standardization, and clinical skills in reperfusion and standardized drug treatment still need to be further improved. Compared with AMI patients in Western medicine hospitals during the same period, those in TCM hospitals had the following characteristics: they were admitted to hospital later; they were older when they had a heart attack; there were more females, they had more problems in their medical history, and they had more concomitant illnesses and complications. Therefore, the demographic baseline data were significantly different between AMI patients in TCM hospitals and those in Western medicine hospitals. This indicated that patients in TCM hospitals were more critical than those in Western medicine hospitals. Conclusions: TCM has special advantages in treating AMI. TCM hospitals are making continuous progress in standardized treatment of AMI, but further improvement is still required. AMI patients in TCM hospitals have some special characteristics, and their condition may be more critical. Further clinical research on TCM treatment of AMI is required.     

Evaluation of the effect of PTCR/PTCA by 99mTc-MIBI myocardial imaging in acute and old myocardial infarction.

This study is to clarify the ability of technetium-99m-Hexakis-2-methoxyisobutyl isonitrile(MIBI) myocardial scintigraphy for assessment of the effect of PTCR/PTCA as compared with conventional thallium-201 myocardial scintigraphy (201Tl). 99mTc-MIBI (740-888MBq) was injected before emergency PTCR/PTCA, and the initial imaging was performed immediately after PTCR/PTCA in 4 patients with acute myocardial infarction (AMI). On the other hand, in 2 patients with old myocardial infarction (OMI), 201Tl and MIBI myocardial imagings were performed before and one week after rescue PTCA. The defect area on the follow-up MIBI imaging was smaller than that on the initial MIBI imaging in 2 patients with successful emergency PTCR/PTCA. But in the other 2 AMI patients with unsuccessful reperfusion, the defect area did not significantly decrease after PTCR/PTCA. Reperfusion was successful in one of the two patients with OMI. In both the two patients with OMI, the MIBI defect area did not significantly decrease after rescue PTCA. MIBI myocardial scintigraphy is a useful noninvasive method for evaluating the effect of emergency PTCR/PTCA for myocardial salvage in patients with AMI, because MIBI is a kit type agent, and it does not redistribute.

     

Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing

Background Cumulative evidence demonstrates that primary percutaneous coronary intervention（PCI）is a mperfusion strategy for ST-elevation myocardial Infarction（STEMI）.This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital（SH group）or a large hospital（LH group）.Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group（n=160）was significantly longer than in the LH group（n=406）（225 vs.120 minutes,P〈0.001）.Multivariate analysis showed that interpreting symptoms to non-cardiac origin（OR,1.996;95%CI： 1.264-3.155）,absence of history of myocardial infarction（OR,1.595;95%CI：1.086-3.347）,non-health insuranca coverage（OR,1.931;95%Cl：1.079-3.012）and absence of sense of impending doom （OR,4.367;95%CI：1.279-1 4.925） were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times（95% CI： 1.1 82-3.661） less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients＇pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.     

Impact of different clinical pathways on outcomes of patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the RAPID-AMI study

Background Current guidelines support primary percutaneous coronary intervention （primary PCI） as the first treatment of choice （as opposed to thrombolytic therapy） for patients with acute ST-segment elevation myocardial infarction （STEMI） especially when delivered within 12 hours of symptom onset. We aimed to evaluate the impact of different clinical pathways on reduction of reperfusion delay and subsequent improvement in outcomes in patients with STEMI. Methods From November 2005 to November 2007, 546 consecutive patients with definite STEMI, who upon arrival at the emergency room were triaged to undergo primary PCI, were included. Of them, 271 patients were brought directly to catheterization laboratory （rapid group）, and 275 patients were admitted to the coronary care unit （CCU） or cardiac ward first, and then transferred to the catheterization laboratory （non-rapid group）. Primary endpoint was door-to-balloon （D2B） time, and secondary endpoints included infarct size assessed by peak CK-MB level and rates of major cardiac adverse events （MACE） including death, reinfarction, or target-vessel revascularization during hospitalization and at 30-day clinical follow-up.
Results Baseline clinical characteristics, angiographic features and procedural success rates were comparable between the two groups, except that more patients received glycoprotein lib/Ilia receptor inhibitors before angiography （84.0% and 77.1, P=0.042） and had TIMI 3 flow in the culprit vessel at initial angiogram （17.1% and 9.2%, P=0.007） in the non-rapid group. The D2B time was shortened （（108±44） minutes and （138±31） minutes, P 〈0.0001）, and number of patients with D2B time 〈90 minutes was greater （22.6% and 10.9%, P 〈0.0001） in the rapid group. The advantages associated with rapid intra-hospital transfer were enhanced if the patients presented to the hospital at regular hours. Peak CK-MB level was significantly reduced in the rapid group. In-hospital mortality （4.1% and 5.8%） and cumulative MACE rate （7.0% and 9.8%） did not significantly differ between rapid and non-rapid groups. At 30 days, cumulative death- and MACE-free survival rates were improved in the rapid group （94.5% and 89.5%, P=0.035; 90.1% and 84.0%, P=0.034, respectively）.
Conclusions Clinical pathway with bypass of CCU/cardiac ward admission was associated with rapid reperfusion, smaller infarct size, and improved short-term survival for patients with STEMI undergoing primary PCI. In the future, it is essential to reduce the time delay for patients presenting at off-hours.     

Impact of Chinese guidelines for management of patients with acute myocardial infarction on outcomes of hospitalized patients

Background The first Chinese guidelines for the diagnosis and management of patients with acute myocardial infarction （AMI） were issued by the Cardiovascular Branch of the Chinese Medical Association, the Editorial Board of the Chinese Journal of Cardiology, and the Editorial Board of the Chinese Circulation Journal in December 2001. However, it is still unclear whether these guidelines have produced a major impact on clinical practice and patient outcomes. The purpose of this study was to evaluate the impact of these guidelines on the management and prognosis of Chinese patients with AMI. Methods A retrospective study was carried out in patients with AMI who were admitted to Qilu Hospital of Shandong University from January 1994 to December 2004. Patients were divided into two groups： group A included patients admitted from January 1994 to December 2001, and group B comprised those admitted from January 2002 to December 2004. Therapeutic approaches and the occurrence rate of angina pectoris, reinfarction, heart failure and death during hospitalization were compared between two groups. Results A total of 1783 patients including 1208 cases in group A and 575 cases in group B were enrolled in this study. No significant difference was found in baseline characteristics between group A and group B patients （all P〉0.05）. There were more patients undergoing reperfusion therapy within the first 24 hours after symptom onset in group B than in group A （35.8% vs 21.7%, P〈0.001） . Administration of β-blockers, angiotensin-converting-enzyme inhibitors （ACEIs）, angiotensin receptor blockers （ARBs）, statins, and heparins were more commonly seen in group B than in group A （P〈 0.001）. There were no significant differences in the use of nitrates or antiplatelet drugs between groups A and B （98.8% vs. 97.9%, P=0.172, and 97.4% vs 98.6%, P=0.113, respectively）. In-hospital angina pectoris, heart failure and death were all lower in group B than in group A （ 32.2% vs 41.2%, P〈0.001; 17.2% vs 26.2%, P〈0.001; and 6.4% vs 9.4%, P=0.038, respectively）. There was no significant difference in the rate of reinfarction between group A and B patients （2.2% vs 1.7%, P=0.492）. Conclusions Chinese guidelines for the management of patients with AMI issued in December 2001 resulted in changes in therapy that led to a significant improvement of in-hospital outcomes but not in the rate of reinfarction in patients with AMI.     

急性心肌梗死病人溶栓治疗前后QT离散度的变化

目的　观察急性心肌梗死 (AMI)病人溶栓治疗前后QT离散度 (QTd)动态变化及早期再灌注对QTd的影响。②方法　对 34例AMI病人给予静脉溶栓治疗 ,于溶栓治疗前后同步记录 12导联心电图 ,计算QTd .③结果　AMI组溶栓治疗前QTd与正常对照组比较明显增高 (t=18.70 0 ,P <0 .0 0 1) ;血管再通组QTd较血管未通组降低程度更大、速度更快 (t=3.46 8,3.473,P <0 .0 1) ,溶栓 3h后QTd较溶栓前即明显降低 (t=4.195 ,P <0 .0 0 1)。④结论　成功的溶栓治疗 ,尽早地恢复血流再灌注 ,可明显降低QTd .     

厄贝沙坦对兔急性心肌梗死再灌注后局部心肌组织中血管紧张素Ⅱ及无复流的影响

目的评价厄贝沙坦对兔急性心肌梗死（AMI）再灌注后血管紧张素Ⅱ（AngⅡ）的影响及对无复流的防治作用。方法新西兰大白兔24只随机分成对照组、厄贝沙坦组[3 mg/（kg.d）]和假手术组,每组8只。将冠状动脉结扎60 min、松解90 min,制备AMI再灌注模型。梗死前、后和再灌注后用导管法进行血流动力学测定。采用ELISA法检测心肌组织中AngⅡ的水平。结果与对照组相比,厄贝沙坦组虽然能升高兔AMI再灌注后心肌组织复流区中AngⅡ的含量（P〈0.01）,但与对照组相比,厄贝沙坦组可促进AMI后心功能的恢复,减少无复流的面积。结论厄贝沙坦虽能升高局部心肌组织中的AngⅡ水平,但却能有效地减轻无复流区的面积,能有效地防治心肌梗死再灌注后无复流现象的发生。     

兔急性心肌梗死模型血运再通的实验研究

目的:研究急性心肌梗死血运再通与心交感神经损伤关系。方法:完全闭塞12只雄性新西兰大白兔冠状动脉左前降支45min后血运再通4h,以131碘-间位碘代苄胍(131I-MIBG)、99m锝-甲氧基异丁基异腈(99mTc-MIBI)双核素放射自显影,并对照两种自显影与TTC组织染色间的联系。结果:血运再通4h,TTC组织染色面积缺损百分比小于无血运再通组,131I-MIBG及99mTc-MIBI自显影在同一区域摄取存在差异性,以急性无血运再通组,131I-MIBG缺损面积(38.8±3.1)%比组织TTC染色及99mTc-MIBI显影缺损大(P<0.001)。结论:急性无血运再通心肌梗死,心交感神经末梢颗粒损害敏感早而广,血运再通早能阻止神经损伤,本实验以MIBG显影,能够监测心肌梗死病变心交感神经活性改变。     

急性心肌梗塞患者血浆内皮素的变化

目的；研究急性心肌梗塞（ＡＭＩ）患者血浆内皮素（ＥＴ）的变化。方法ＡＭＩ患者随机分溶栓（１７例）与非溶栓（１４例）两组，溶栓组分为溶栓成功组９例（早期再灌），溶栓未成功组８例（非早期再灌）。测外周血浆ＥＴ值，并于入院后３周左右行彩色多普勒扫描。结果：ＡＭＩ患者入院初血浆ＥＴ浓度明显高于正常组，早期财灌较非再灌高山筻 高及高山箭移且持续时间短，各组ＥＴ峰值性与彩色多普勒测得左室射血分数（ＬＶＥＦ）无     

Establishment and evaluation of a swine model of acute myocardial infarction and reperfusion–ventricular fibrillation–cardiac arrest using the interventional technique

BackgroundVentricular fibrillation is the main cause of sudden cardiac death among patients with acute myocardial infarction (AMI). Substantial benefits could be obtained by both researchers and practitioners if an AMI reperfusion-ventricular fibrillation-cardiac arrest model were established.MethodsTwenty swine were anesthetized and underwent occlusion of the left anterior descending branch for 90 minutes prior to blood reperfusion. Throughout this process, continuous 12-lead electrocardiography (ECG) was used to monitor heart rate, rhythm, and electrocardiogram alteration. Thereafter, AMI was confirmed by ECG and left ventricular angiography. Heart tissue was collected for pathological analysis, and for evaluation of the establishment of a model of AMI reperfusion.ResultsSeven swine died during the model establishment, and the 13 surviving swine were proven to have myocardial infarction; nine of those survivors had ventricular fibrillation–cardiac arrest after reperfusion based on the electrocardiograph and pathological examination.ConclusionBlocking the left anterior descending branch by inflation of an over-the-wire coronary balloon catheter in swine can result in successful establishment of a swine model of AMI and reperfusion–ventricular fibrillation–cardiac arrest, with good reproducibility and a high survival rate.     

Effects of Tongxinluo-facilitated cellular cardiomyoplasty with autologous bone marrow-mesenchymal stem cells on postinfarct swine hearts

Background  Treatment of ischemic heart disease remains an important challenge, though there have been enormous progresses in cardiovascular therapeutics. This study was conducted to evaluate whether Tongxinluo (TXL) treatment around the transplantation of mesenchymal stem cells (MSCs) can improve survival and subsequent activities of implanted cells in swine hearts with acute myocardial infarction (AMI) and reperfusion.
Methods  Twenty-eight Chinese mini-pigs were divided into four groups including a control group (n=7); group 2, administration of low-dose TXL alone from the 3rd day prior to AMI to the 4th day post transplantation (n=7); group 3, MSCs alone (n=7) and group 4, TXL + MSCs (n=7). AMI models were made by occlusion of the left anterior descending coronary artery for 90 minutes. Autologous bone marrow-MSCs (3×10⁷ cells/animal) were then injected into the post-infarct myocardium immediately after AMI and reperfusion. The survival and differentiation of implanted cells in vivo were detected by immunofluorescent analysis. The data of cardiac function were obtained at baseline (1 week after transplantation) and endpoint (6 weeks after transplantation) by single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Apoptosis was detected by TUNEL assay and the oxidative stress level was investigated in the post-infarct myocardium at endpoint.
Results  At endpoint, there was less fibrosis and inflammatory cell infiltration with more surviving myocardium in group 4 than in the control group. In group 4 the survival and differentiation of implanted MSCs were significantly improved more than that seen in group 3 alone (P<0.0001); the capillary density was also significantly greater than in the control group, group 2 or 3 both in the infarcted zone (P<0.0001) and the peri-infarct zone (P<0.0001). MRI showed that parameters at baseline were not significantly different between the 4 groups. At endpoint, regional wall thickening and the left ventricular ejection fraction were increased while the left ventricular mass index, dyskinetic segments and infarcted size were decreased only in group 4 compared with control group (P<0.0001). SPECT showed that the area of perfusion defect was significantly decreased at endpoint only in group 4 compared with control group (P<0.0001). TUNEL assay indicated that TXL administration significantly decreased cell apoptosis in peri-infarct myocardium in groups 2 and 4. Furthermore, superoxide dismutase (SOD) significantly increased and malondialdehyde (MDA) decreased in groups 2 and 4 by the administration of TXL.
Conclusions  Our study demonstrates the following: (1) immediate intramyocardial injection of MSCs after AMI and reperfusion resulted in limited survival and differentiation potential of implanted cells in vivo, thus being incapable of beneficially affecting post-hearts; (2) TXL-facilitation resulted in a significant survival and differentiation potential of implanted cells in vivo via inhibition of apoptosis and oxidative stress, accompanied by significant benefits in cardiac function.

     

冠脉内溶栓与冠脉成形术对再灌性心律失常的影响

观察８例冠心病患者，其中急性心肌梗塞６例，所梗塞的相关动脉完全闭塞；２例不稳定型心绞痛，左前降支有多节段狭窄，严重处狭窄达９５％。经冠脉内溶栓或冠脉成形术后，８例获血管再通或增强灌注，均发生心律失常。对其发生机制进行了探讨。     

心肌缺血再灌注损伤的防治新靶点寻找及其研究进展

急性心肌梗死（AMI）及心力衰竭并发症的发病率和病死率在全世界居高不下。经证实心肌梗死后冠状动脉的早期再灌注是典型而有效的治疗方法，但侧支和冠脉缺血再灌注损伤（MIRI）及相关心脏保护机制尚不清楚。AMI的发生机制是多因素的，它通过多种机制导致心肌细胞死亡，并影响其他类型的细胞，包括血小板、成纤维细胞、内皮细胞和平滑肌细胞以及免疫细胞。大多数心脏保护策略通过常见的终末效应物发挥作用，但在合并症患者中的效果可能并不理想。因此，研究触发和治疗MIRI病理生理学相关的多靶点防治策略有重要意义。特别关注心脏保护策略现状，以此简单阐述参与防治心肌缺血再灌注损伤的多靶点治疗组合以及在研新靶点，以期为MIRI的机制研究与新药研发提供思路。