80岁以上高龄急性心肌梗死患者研究进展

急性心肌梗死(AMI)是老年人病死率高的主要病因之一。药物溶栓和介入治疗是临床上常规使用的治疗手段,能显著降低患者的病死率,改善预后。然而,高龄心肌梗死患者在临床上常并发多种疾病,出血风险较高,不论是药物溶栓还是介入治疗都有一定的禁忌和风险。针对高龄AMI患者的再灌注治疗仍缺少广泛的大规模数据支持,使患者预后更有益的治疗手段存在争议。笔者回顾了80岁以上ST段抬高型心肌梗死以及非ST段抬高型心肌梗死患者的国内外研究现状,比较了介入治疗与药物溶栓的治疗方法,旨在为高龄AMI患者的临床选择提供参考依据。     

EXPORT抽吸导管在急性心肌梗死患者经皮冠状动脉介入治疗中的应用

目前，经皮冠状动脉介入治疗（PCI）替代了传统的药物治疗，已成为治疗急性心肌梗死（AMI）的重要方法。     

急诊经皮冠状动脉介入治疗老年急性心肌梗死合并心源性休克56例

老年急性心肌梗死(AMI)合并心源性休克时,药物溶栓等内科药物治疗病死率高,约85%～90%〔1〕。药物溶栓治疗能够降低AMI后心源性休克的发生率,但是一旦发生心源性休克,患者可出现循环功能障碍,则溶栓治疗的效果较差〔2〕。经皮冠状动脉介入治疗(PCI)能迅速使梗死相关血管(IRA)充分开     

急性心肌梗死患者直接经皮冠状动脉介入术后心血管事件发生的影响因素研究现状

<正>急性心肌梗死(acute myocardial infarction,AMI)主要是因冠状动脉狭窄或闭塞,冠状动脉血流持续减少或中断,所导致的心肌细胞缺血坏死。AMI做为冠心病中的急危重症,具有较高的致死、致残率。早期、快速地再灌注治疗是改善AMI患者预后的关键,包括药物溶栓、介入治疗及冠状动脉旁路移植术(coronary artery bypass grafting,CABG)。随着介入技术不断的进步、临床经验的积累,药物支架的改进,介入治疗成为急性心肌梗死的主要治疗措施。回顾国内外大量     

急性心肌梗死的急诊再灌注介入治疗

对急性心肌梗死（AMI）患者直接行经皮腔内冠状动脉成形术（PTCA）临床效果良好。根据AMI发生后行PTCA的时间及与溶栓的关系，AMI急诊介入治疗可分为直接PTCA，补救PTCA，即刻PTCA和延期PTCA，近年还诞生了冠状动脉（冠脉）内支架相干入术等新的介入治疗技术，联合使用新的抗凝，抗血小板药的疗效也得到评价。本文对直接PTCA，补救PTCA，即刻PT-CA，延期PTCA，原发支架植入术和药物辅助性介入治疗的最新进展作一综述。     

雷帕霉素药物洗脱支架用于急诊PCI的安全性评价

110例起病12h内接受急诊经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者，按介入治疗时使用的支架分为雷帕霉素药物洗脱支架组（A组，50例）和金属裸支架组（B组，60例）。结果两组PCI术均获得成功，A组无1例发生急性和亚急性血栓形成，B组1例发生急性血栓形成。提示雷帕霉素药物洗脱支架应用于AMI是安全的。     

急性心肌梗死多支血管病变经皮冠脉介入治疗一次性完全血运重建的住院期间和长期预后

由于潜在增加并发症的危险性，目前指南并不主张在急性心肌梗死（AMI）早期对多支血管病变进行经皮冠脉介人治疗（PCI）一次性完全血运重建（多支血管PCI）。然而，随着介入治疗技术的快速进展及新型抗血小板药物的应用，多支血管PCI的安全性和长期预后有待重新验证。该研究对AMI（ST段抬高AMI和非ST段抬高AMI）早期进行多支血管PCI的预后进行了评价。     

以急性心肌梗死首诊的真红细胞增多症1例

急性心肌梗死发病率高，少部分急性心肌梗死继发于其他疾病，真性红细胞增多症的血栓发生机率高，但是以AMI首发并行介入治疗成功的个案少见。这些患者的病情复杂多变，治疗方法多在摸索与探讨。报道1例以PV合并AMI首诊的个案特点、诊断、治疗及随访情况，从实验室检查、药物选择、介入术式的选择几方面分析该单纯PV合并AMI，无其他危险因素的典型病例，以期探索规范化的诊疗及治疗的方案，减少死亡率，提高治愈率。     

国产乐普药物涂层支架与进口裸支架在急性心肌梗死经皮冠状动脉介入治疗中的疗效比较

急性心肌梗死（AMI）急诊直接经皮冠状动脉介入治疗（PCI）的疗效优于溶栓治疗,进口雷帕霉素药物洗脱支架在急性心肌梗死急诊PCI应用的安全性和有效性已有报道。我们将国产乐普药物涂层支架与进口vison裸支架的疗效进行比较,以探讨其在AMI患者中应用的安全性和有效性。     

高龄急性心肌梗死患者介入治疗的临床分析

目的：对比介入治疗与保守治疗高龄老年（≥75岁）急性心肌梗死（AMI）患者的近期及中期临床疗效。方法：回顾性分析62例高龄AMI患者住院期间的临床资料。分为冠脉介入（PCI）治疗组30例和保守治疗组32例，对比观察梗死后死亡率、心肌酶学、心功能、心室重构及心律失常情况．结果：统计分析显示：和保守治疗组比较，介入治疗组病死率，心绞痛发生率，夜间阵发性呼吸困难发生率，平均住院时间，左房扩大率，左室扩大率，室壁瘤形成率，室上性及室性心律失常发生率显著减少，左室射血分数明显增加，P均〈0．05。结论：介入治疗可有效地治疗高龄AMI患者，保护心室功能，减少合并症，降低死亡率。     

Management of acute myocardial infarction during the COVID‐19 pandemic

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID‐19). Although there is an association between cardiovascular disease and COVID‐19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID‐19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID‐19 era. Cardiovascular manifestations of COVID‐19 are complex with patients presenting with AMI, myocarditis simulating an ST‐elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non‐ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID‐19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on (a) varied clinical presentations; (b) appropriate personal protection equipment (PPE) for health care workers; (c) the roles of the emergency department, emergency medical system, and the cardiac catheterization laboratory (CCL); and (4) regional STEMI systems of care. During the COVID‐19 pandemic, primary percutaneous coronary intervention (PCI) remains the standard of care for STEMI patients at PCI‐capable hospitals when it can be provided in a timely manner, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis‐based strategy may be entertained at non‐PCI‐capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.     

In-hospital outcomes of primary percutaneous coronary interventions performed at hospitals with and without on-site coronary artery bypass graft surgery.

BACKGROUND: Primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is performed in hospitals without on-site coronary artery bypass graft surgery in the ;real world'. However, data on the in-hospital outcomes of primary PCI performed at hospitals with and without on-site cardiac surgery are still lacking in Japan. METHODS AND RESULTS: In the present study, 2,230 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2005. Of these, 1,817 patients underwent primary PCI. Excluding patients without adequate data, we retrospectively compared clinical background, coronary risk factors, angiographic findings, acute results of primary PCI and in-hospital prognosis between patients undergoing primary PCI in hospitals without on-site cardiac surgery (without surgery group, n=792) and those in hospitals with (with surgery group, n=993). The without surgery group had higher prevalence of previous myocardial infarction, Killip class>or=3 at admission and multivessels as a culprit lesion than the with surgery group. The without surgery group was more likely to have lower frequency of stent usage and lower thrombolysis in myocardial infarction flow grade just after PCI, whereas it was more likely to have intra-aortic balloon pumping and temporary pacing during procedures. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class>or=3 at admission, multivessels or left main trunk (LMT) as culprit lesions, number of diseased vessels>or=2 or diseased LMT, and age were the independent predictors of the in-hospital mortality, but the presence of on-site cardiac surgery was not. CONCLUSIONS: These results suggest that in-hospital outcomes in AMI patients undergoing primary PCI at hospitals without on-site cardiac surgery are comparable to those at hospitals with on-site cardiac surgery in Japan.     

Long-term trends in the use of coronary reperfusion strategies in acute myocardial infarction: a community-wide perspective

Background The objectives of our study were to examine long-term (1986–2003) trends in the use of percutaneous coronary interventions (PCI) and thrombolytic therapy in the management of patients hospitalized with acute myocardial infarction (AMI) while our secondary study goal was to examine factors associated with use of these coronary reperfusion strategies. While there have been considerable changes in the management of patients hospitalized with AMI over time, limited contemporary data are available about changing trends in the use of different coronary reperfusion strategies, particularly from the more generalizable perspective of a population-based investigation. Methods The study sample consisted of 9,422 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003. Results Divergent trends in the use of PCI and thrombolytic therapy during hospitalization for AMI were noted. Use of thrombolytic therapy increased after its introduction to clinical practice in the mid-1980’s through the early 1990’s with a progressive decline in use thereafter. In 2003, 3.5% of patients hospitalized with AMI were treated with clot lysing therapy. On the other hand, marked increases in the use of PCI during hospitalization for AMI were noted over time. In 2003, 42.1% of patients with AMI received a PCI. Several demographic and clinical factors were associated with the use of these different treatment strategies. Conclusions The results of our study in a large Northeast community suggest evolving changes in the hospital management of patients with AMI. Current management practices emphasize the utilization of PCI to restore coronary reperfusion to the infarct related artery. Condensed Abstract We examined long-term trends in the use of percutaneous coronary interventions (PCI) and thrombolytic therapy in the management of patients hospitalized with acute myocardial infarction (AMI). The study sample consisted of 9,422 greater Worcester (MA) residents hospitalized with AMI at all area medical centers between 1986 and 2003. Use of thrombolytic therapy increased from the mid-1980’s through the early 1990’s with a progressive decline in use thereafter. In 2003, 3.5% of patients hospitalized with AMI were treated with clot lysing therapy. Marked increases in the use of PCI during hospitalization for AMI were noted. In 2003, 42.1% of patients hospitalized with AMI received a PCI.     

Rates of primary percutaneous coronary intervention worldwide.

BACKGROUND: Primary percutaneous coronary intervention (PCI) is at present the most effective procedure for reducing the mortality rate of patients with acute myocardial infarction (AMI). However, there is a great difference between Japan and other countries in the rate of primary PCI. METHODS AND RESULTS: Registration period, number of patients with AMI, rates of primary PCI or thrombolysis and in-hospital or 30-day mortality rates were analyzed in 3 Japanese, 4 European, 4 American and 2 world-wide databases of AMI. The primary PCI rate is higher (75-94%) in Japan than in the other countries (5.5-49.6%), particularly in low-volume hospitals, and the mortality rates at these centers were similar to those in high-volume hospitals (approximately 4-10%). The primary PCI rate has recently been rising (25-50%) worldwide and most PCI procedures are performed in large-volume centers, except in Japan. CONCLUSIONS: Comparison of the AMI databases suggest there is a relationship between the primary PCI rate and annual PCI caseload in each country. It is interesting that in Japan even low-volume PCI hospitals have comparable numbers of primary PCI cases.     

Effect of emergency percutaneous coronary intervention on in-hospital mortality of very elderly (80+ years of age) patients with acute myocardial infarction

It is still controversial whether percutaneous coronary intervention (PCI) is effective in improving in-hospital survival in very elderly patients. Therefore, using data from the Tokai Acute Myocardial Infarction Study II, we studied the effect of emergency PCI on the in-hospital mortality of very elderly (80+ years of age) patients with acute myocardial infarction (AMI). The study was a prospective study of all consecutive patients admitted to the 15 acute care hospitals in the Tokai region with the diagnosis of AMI from 2001 to 2003. A total of 211 patients undergoing emergency PCI and 176 patients not undergoing PCI were included in the present analysis. We compared the baseline and procedural characteristics and the clinical outcomes between the 2 groups. Patients without emergency PCI were older and had an increased prevalence of female gender, ADL impairment, and dementia in comparison with those with PCI. They also showed poorer clinical conditions. They were less likely to be transferred to intensive care or coronary care units and to be given intra-aortic balloon pumps. The patients with emergency PCI had nearly one-third the in-hospital mortality rate of the patients without emergency PCI. According to multivariate analysis, emergency PCI was still identified as an independent predictor of in-hospital death, with an adjusted odds ratio of 0.26 (95% CI, 0.07-0.97). The results indicated that emergency PCI has a preventative effect on in-hospital mortality in Japanese AMI patients 80 years of age and older.     

Effect of hospital case volume on treatment and in-hospital outcomes in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Results from the Ibaraki Coronary Artery Disease Study (ICAS) Registry

The volume of percutaneous coronary interventions (PCI) performed in a hospital has been suggested to correlate with favorable outcomes in patients undergoing primary PCI for acute myocardial infarction (AMI). However, studies that use current data and compare treatment and outcomes for AMI among hospitals with different volumes are still limited in Japan. Between January 2004 and March 2006, 401 AMI patients underwent primary PCI in the 11 hospitals participating in the Ibaraki Coronary Artery Disease Study (ICAS). Clinical characteristics, treatment, and in-hospital outcomes were retrospectively compared between 254 patients admitted to high-volume PCI hospitals and 147 patients admitted to low-volume hospitals. Low-volume hospitals had a higher prevalence of multivessel disease patients. High-volume hospitals had longer onset-to-door times, which were offset by faster door-to-balloon times. Rates of coronary stent use and successful PCI were comparable between the groups. Low-volume hospitals more frequently performed intra-aortic balloon pumping. Length of stay was longer in low-volume hospitals, whereas in-hospital mortality, bypass surgery, and repeat PCI rates did not differ between groups. Although the present study assessed limited data based on small sample size, we observed that contemporary standard treatments including stent implantation were performed for AMI patients undergoing primary PCI in hospitals with both high and low case volumes. We did not find an obvious relationship between hospital PCI volume and in-hospital outcomes in our data. However, further prospective surveys should be attempted to confirm these results.     

Rationale and strategies for implementing community-based transfer protocols for primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

The focus for the initial approach to the treatment of acute ST-segment elevation myocardial infarction (STEMI) has shifted toward extending the benefits of mechanical reperfusion with primary percutaneous coronary intervention (PCI) to patients who present to community hospitals that have no interventional capabilities. Several randomized clinical trials have shown that transferring STEMI patients to tertiary centers for primary PCI leads to better outcomes than when fibrinolytic therapy is administered at community hospitals. Furthermore, potent pharmacologic reperfusion regimens that enhance early reperfusion of the infarct vessel before primary PCI may enhance the positive result of the transfer approach. Despite these promising findings, several obstacles have hindered the adoption of patient-transfer strategies in the U.S., including greater distances between community and tertiary hospitals, a lack of integrated emergency medical services, and the medical community's limited experience with centralized acute myocardial infarction (AMI) care networks. Nonetheless, the implementation of system-wide changes in the care of STEMI patients analogous to the creation of trauma networks could facilitate the creation and ongoing evaluation of dedicated patient transfer strategies and better early invasive care in the U.S. Within this context, a systematic, stepwise approach to the creation of AMI care networks and to the development of standard nomenclature and performance indicators is necessary to guide quality assurance monitoring and future research efforts as the care of STEMI patients is redefined. Consequently, this current evolution of reperfusion strategies has the potential to further reduce morbidity and mortality for patients presenting with STEMI.     

Effects of hospital volume of primary percutaneous coronary interventions on angiographic results and in-hospital outcomes for acute myocardial infarction.

BACKGROUND: Several clinical studies have demonstrated an inverse relationship between hospital volume of primary percutaneous coronary interventions (PCI) and in-hospital mortality. However, the relationships among hospital primary PCI volume, angiographic results, and in-hospital prognosis in patients with acute myocardial infarction (AMI) have not been fully investigated in Japan. METHODS AND RESULTS: Using the AMI-Kyoto Multi-Center Risk Study database between January 2000 and December 2005, hospitals were classified into quintiles based on their annual volume of primary PCI. The fifth quintile of hospitals was labeled as high-volume, and the other quintiles were combined and defined as low-volume. Although patients undergoing primary PCI in high-volume hospitals (high-volume group, n=764) had a larger number of diseased vessels at initial coronary angiography and lower Thrombolysis In Myocardial Infarction (TIMI) flow grade in the infarct-related artery before PCI, compared with those in low-volume hospitals (low-volume group, n=1,021), the rates of achieving TIMI flow grade 3 just after PCI in the high-volume group was significantly higher than that in the low-volume group. The overall in-hospital mortality did not differ between the 2 groups. On multivariate analysis, in AMI patients undergoing primary PCI, Killip class >or=3 at admission, multivessel disease or left main trunk (LMT) as culprit lesion, number of diseased vessels >or=2 or diseased LMT, and age were the independent positive predictors of in-hospital mortality, whereas the TIMI flow grade 3 after primary PCI and elapsed time <24 h were the negative ones, but not low-volume hospital. CONCLUSIONS: Angiographic results of primary PCI in high-volume hospitals were superior to those in low-volume hospitals, but there was no significant difference in the in-hospital mortality between AMI patients in high-volume hospitals and those in low-volume hospitals.     

Rationale and design of a large-scale trial using atrial natriuretic peptide (ANP) as an adjunct to percutaneous coronary intervention for ST-segment elevation acute myocardial infarction: Japan-Working groups of acute myocardial infarction for the reduction of Necrotic Damage by ANP (J-WIND-ANP).

BACKGROUND: The benefits of percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are limited by reperfusion injury. In animal models, atrial natriuretic peptide (ANP) reduces infarct size, so the Japan-Working groups of acute myocardial Infarction for the reduction of Necrotic Damage by ANP (J-WIND-ANP) designed a prospective, randomized, multicenter study, to evaluate whether ANP as an adjunctive therapy for AMI reduces myocardial infarct size and improves regional wall motion. METHODS AND RESULTS: Twenty hospitals in Japan will participate in the J-WIND-ANP study. Patients with AMI who are candidates for PCI are randomly allocated to receive either intravenous ANP or placebo administration. The primary end-points are (1) estimated infarct size (Sigmacreatine kinase and troponin T) and (2) left ventricular function (left ventriculograms). Single nucleotide polymorphisms (SNPs) that may be associated with the function of ANP and susceptibility of AMI will be examined. Furthermore, a data mining method will be used to design the optimal combinational therapy for post-MI patients. CONCLUSIONS: J-WIND-ANP will provide important data on the effects of ANP as an adjunct to PCI for AMI and the SNPs information will open the field of tailor-made therapy. The optimal therapeutic drug combination will also be determined for post-MI patients.     

Rationale and design of a large-scale trial using nicorandil as an adjunct to percutaneous coronary intervention for ST-segment elevation acute myocardial infarction: Japan-Working groups of acute myocardial infarction for the reduction of Necrotic Damage by a K-ATP channel opener (J-WIND-KATP).

BACKGROUND: The benefits of percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI) are limited by reperfusion injury. In animal models, nicorandil, a hybrid of an ATP-sensitive K(+) (KATP) channel opener and nitrates, reduces infarct size, so the Japan-Working groups of acute myocardial Infarction for the reduction of Necrotic Damage by a K-ATP channel opener (J-WIND-KATP) designed a prospective, randomized, multicenter study to evaluate whether nicorandil reduces myocardial infarct size and improves regional wall motion when used as an adjunctive therapy for AMI. METHODS AND RESULTS: Twenty-six hospitals in Japan are participating in the J-WIND-KATP study. Patients with AMI who are candidates for PCI are randomly allocated to receive either intravenous nicorandil or placebo. The primary end-points are (1) estimated infarct size and (2) left ventricular function. Single nucleotide polymorphisms (SNPs) that may be associated with the function of KATP-channel and the susceptibility of AMI to the drug will be examined. Furthermore, a data mining method will be used to design the optimal combined therapy for post-myocardial infarction (MI) patients. CONCLUSIONS: It is intended that J-WIND-KATP will provide important data on the effects of nicorandil as an adjunct to PCI for AMI and that the SNPs information that will open the field of tailor-made therapy. The optimal therapeutic drug combination will also be determined for post-MI patients.