急性心肌梗死静脉溶栓治疗和心电监护的体会

目的探讨静脉溶栓治疗和心电监护对急性心肌梗死(AMI)的疗效。方法全部病例均符合WHO规定的AMI诊断标准,治疗均给予尿激酶(UK)100 U～150万U,加生理盐水100 ml,静脉点滴,30 min滴完。同时给予心电监护,以期能及时发现患者存在的各种心律失常。结果本组72例中,均无牙齿出血、消化道出血及出血性脑卒中等并发症的发生,1例出现静脉穿刺部位皮肤瘀斑;所有患者均好转出院。结论静脉溶栓治疗和心电监护对急性心肌梗死(AMI)的疗效可靠,值得在基层医院使用。     

New Horizons of Acute Myocardial Infarction: From the Korea Acute Myocardial Infarction Registry

As the first nationwide Korean prospective multicenter data collection registry, the Korea Acute Myocardial Infarction Registry (KAMIR) launched in November 2005. Through a number of innovative approaches, KAMIR suggested new horizons about acute myocardial infarction (AMI) which contains unique features of Asian patients from baseline characteristics to treatment strategy. Obesity paradox was existed in Korean AMI patients, whereas no gender differences among them. KAMIR score suggested new risk stratifying method with increased convenience and an enhanced accuracy for the prediction of adverse outcomes. Standard loading dose of clopidogrel was enough for Asian AMI patients. Triple antiplatelet therapy with aspirin, clopidogrel and cilostazol could improve clinical outcomes than dual antiplatelet therapy with aspirin and clopidogrel. Statin improved clinical outcomes even in AMI patients with very low LDL-C levels. The rate of percutaneous coronary intervention was higher and door-to-balloon time was shorter than the previous reports. Zotarolimus eluting stents as the 2nd generation drug-eluting stent (DES) was not superior to the 1st generation DES, in contrast to the western AMI studies. KAMIR made a cornerstone in the study of Korean AMI and expected to be new standards of care for AMI with the renewal of KAMIR design to overcome its pitfalls.     

Treatment of Myocardial Infarction: A Review

An overview of the problems and management of acute myocardial infarction is presented. Certain factors that are pertinent to the problem of differential mortality in various population subgroups have been identified. These factors include race, sex, and socioeconomic background.     

Safety and Efficacy of Overlapping Homogenous Drug-Eluting Stents in Patients with Acute Myocardial Infarction: Results from Korea Acute Myocardial Infarction Registry

The aim of this study was to compare safety and efficacy of 4 homogenous overlapping drug-eluting stents (DES) in acute myocardial infarction (AMI) patients. We selected 1,349 consecutive patients (62.1 ± 14.9 yr, 69.4% male) who received homogenous overlapping DESs in diffuse de novo coronary lesions from Korea Acute Myocardial Infarction Registry from April 2006 through September 2010. They were divided into 4 groups based on type of DES implanted - Paclitaxel (PES), Sirolimus (SES), Zotarolimus (ZES) and Everolimus (EES)-eluting stents. Primary endpoint was 12-month MACE. We also studied EES versus other DESs (PES + SES + ZES). Mean stent length was 26.2 ± 7.5 mm and mean stent diameter was 3.1 ± 0.4 mm. Average number of stents used per vessel was 2.2 ± 0.5. Incidence of major adverse cardiac events (MACE) in PES, SES, ZES, and EES groups were 9.5%, 9.2%, 7.5%, and 3.8%, respectively (P = 0.013). In EES group, overall MACE and repeat revascularization were lowest, and no incidence of stent thrombosis was observed. Non-fatal MI was highest in PES, almost similar in SES and EES with no incidence in ZES group (P = 0.044). Cox proportional hazard analysis revealed no differences in the incidence of primary endpoint (P = 0.409). This study shows no significant differences in 12-month MACE among 4 groups.     

急性心肌缺血的动态关联维数

已有的研究成果表明，冠心病患者心脏各导联心电图(ECG)的关联维数D2比正常人均有不同程度的下降。为了进一步研究心肌缺血情况、导联位置和关联维数变化的关系，本研究设计了6只兔子急性心肌缺血实验模型，计算了其不同时间段的12导同步ECG，作出关联维数一时间(D2-T)曲线，结合电生理和解剖学知识，研究了实验结果，发现急性心肌缺血初期ECG的D2值具有动态变化特性，其原因在于心血管中存在代偿作用。ECG的D1的变化反映了单一化的心脏传输网络系统的非线性复杂性的变化。将此结论由动物推广到人，可以为临床上运用D2值分析心肌缺血病症严重程度提供理论指导。     

Percutaneous Coronary Intervention for Acute Myocardial Infarction in Elderly Patients with Renal Dysfunction: Results from the Korea Acute Myocardial Infarction Registry

This study aimed to evaluate the effects of percutaneous coronary intervention (PCI) on short- and long-term major adverse cardiac events (MACE) in elderly (>75 yr old) acute myocardial infarction (AMI) patients with renal dysfunction. As part of Korea AMI Registry (KAMIR), elderly patients with AMI and renal dysfunction (GFR<60 mL/min) received either medical (n=439) or PCI (n=1,019) therapy. Primary end point was in-hospital death. Secondary end point was MACE during a 1 month and 1 yr follow-up. PCI group showed a significantly lower incidence of in-hospital death (20.0% vs 14.3%, P=0.006). Short-term and long-term MACE rates were higher in medical therapy group (31.9% vs 19.0%; 57.7% vs 31.3%, P<0.001), and this difference was mainly attributed to cardiac death (29.3% vs 17.6%; 51.9% vs 25.0%, P<0.001). MACE-free survival time after adjustment was also higher in PCI group on short-term (hazard ratio, 0.67; confidence interval, 0.45-0.98; P=0.037) and long-term follow-up (hazard ratio, 0.61, confidence interval, 0.45-0.83; P=0.002). In elderly AMI patients with renal dysfunction, PCI therapy yields favorable in-hospital and short-term and long-term MACE-free survival.     

Therapeutic Hypothermia for Cardioprotection in Acute Myocardial Infarction

Mild therapeutic hypothermia of 32–35℃ improved neurologic outcomes in outside hospital cardiac arrest survivor. Furthermore, in experimental studies on infarcted model and pilot studies on conscious patients with acute myocardial infarction, therapeutic hypothermia successfully reduced infarct size and microvascular resistance. Therefore, mild therapeutic hypothermia has received an attention as a promising solution for reduction of infarction size after acute myocardial infarction which are not completely solved despite of optimal reperfusion therapy. Nevertheless, the results from randomized clinical trials failed to prove the cardioprotective effects of therapeutic hypothermia or showed beneficial effects only in limited subgroups. In this article, we reviewed rationale for therapeutic hypothermia and possible mechanisms from previous studies, effective methods for clinical application to the patients with acute myocardial infarction, lessons from current clinical trials and future directions.     

BNP和Hs-CRP检测对急性心肌梗死及梗死后心力衰竭的诊断价值

目的:探讨B型钠尿肽(BNP)和超敏C反应蛋白(Hs-CRP)对急性心肌梗死(AMI)和AMI后心力衰竭(HF)的诊断价值。方法:110例初发AMI患者包括未发生HF患者58例和发生HF患者52例,均于入院第2天清晨空腹抽血,进行血浆BNP和血清Hs-CRP检测。结果:有无HF的两组AMI患者BNP、Hs-CRP水平均显著高于健康对照组(P<0.01);AMI后发生HF组BNP、Hs-CRP水平明显高于未发生HF组(P<0.01);BNP与Hs-CRP联合检测对诊断AMI后发生HF的敏感性为88.5%,特异性为81.0%,明显优于BNP或Hs-CRP单项检测。结论:BNP和Hs-CRP在AMI及HF患者中显著升高,两者联合检测对临床诊断和治疗AMI及HF有积极意义。     

急性心肌梗塞患者出院后健康教育需要调查报告

目的通过不同途径满足心肌梗塞患者出院后的健康教育需求。方法采用门诊复查、网络邮件或电话咨询3种方式进行健康教育需要调查,将调查结果进行科学分析。结果心肌梗塞患者出院后存在不同程度的健康教育需要,对诱发因素及预防、病情自我监测方法指导、家庭支持的需要最多,其次对运动与工作指导、性生活指导、饮食指导较重视,但对日常生活注意事项、心理支持没有引起重视。结论大部分患者出院后都有不同的健康需要。让出院患者对健康教育内容引起重视并采取正确康复方法,可防止复发率及并发症的发生,提高其生活质量。     

Influenza Virus Infection and Risk of Acute Myocardial Infarction

Increasing evidences have shown that pathogens might promote atherosclerosis and trigger acute myocardial infarction (AMI). But the conclusions from various studies on the correlation between previous influenza virus (IV) infection and AMI were inconsistent. We conducted a case-control study to assess the association of previous IV infection and AMI. Questionnaire survey was conducted to collect information about demographic characteristics and heart disease risk factors. Fasting blood sample was obtained to measure IgG antibodies to influenza virus A(IV-A), influenza virus B(IV-B), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2), adenovirus (ADV), rubella virus (RV) and Chlamydia pneumoniae (CP) and measure the level of some biochemistry markers. Compared to controls, cases were more likely to have positive IgG antibodies to IV-A and IV-B (IV-A: OR, 3.3; 95%CI, 1.5 to 7.4; IV-B: OR, 17.2; 95%CI, 7.7 to 38.0). After adjustment for potential confounding variables, the risk of AMI was still associated with the presence of IgG antibodies to IV-A (adjusted OR, 7.5; 95%CI, 1.3 to 43.0) and IV-B (adjusted OR, 27.3; 95%CI, 6.6 to 113.8). The study supported the hypothesis that previous IV infection took part in the development of atherosclerosis and trigger the occurrence of AMI.     

通脉散对家兔急性心肌梗塞范围及血小板超微结构的影响

通脉散为治疗冠心病的纯中药制剂。为了探讨其作用机制而采用结扎家兔冠状动脉复制急性心肌梗塞动物模型（NBT染色法），观察通脉散对心肌梗塞范围和血小板形态及超微结构计量学指标的影响。结果表明：通脉散组的心肌梗塞范围和血小板超微结构指标的改变明显低于维拉帕米组（P＜0．05～0.01），通脉散缩小家兔急性心肌梗塞范围的机制可能与其稳定血小板形态及抑制血小板活性物质的释放有关。     

Ventricular Tachycardia in Acute Myocardial Infarction: Clinical Features of 113 Patients

This study was undertaken to evaluate the clinical significance of ventricular tachycardia as a complication of acute myocardial infarction in a large public hospital. An analysis of the clinical, electrocardiographic, therapeutic, and prognostic implications of this large patient group is presented and several unique features emphasized.     

Cardiac Tamponade Due to Rupture of a Subepicardial Aneurysm Following Myocardial Infarction

A 71 year old male died of cardiac tamponade due to cardiac rupture 22 days after onset of acute myocardial infarction. Autopsy revealed rupture of an unusual ventricular aneurysm characterized by abrupt interruption of the myocardium, a narrow neck, a thin fibrous outer wall partially showing myocardial fibers, and lack of adhesion between the epicardium and pericardium. A review of the literature revealed that 11 among 32 autopsy cases of false aneurysm showed a similar morphology to the present case, these being classifiable as subepicardial aneurysm. Acta Pathol Jpn 41: 52 58, 1991.     

Plasma Levels of Procalcitonin and Interleukin-6 in Acute Myocardial Infarction

Estimation of cardiac morbidity in patients after major surgery is a difficult problem. In addition, infectious complications seriously decrease potential beneficial outcome after cardiovascular surgery. The present study assessed the use of a newer marker of the inflammatory response, procalcitonin, in the field of myocardial infarction, in conjunction with measurements of interleukin-6. Forty-four consecutive cases with acute myocardial infarction were included in the study 4 ± 1.3 h after the onset of symptoms. Plasma levels of procalcitonin and interleukin-6 were obtained at admission, and after 3, 6, 12, 18, 24 and 48 h, using commercially available test kits. The range of levels of interleukin-6 and procalcitonin was about normal at admission. Interleukin-6 levels increased significantly following myocardial infarction, whereas procalcitonin were essentially unchanged, i.e. remained close to the normal level threshold of 0.5 ng/ml; only minor variability occurred with a mean peak level of procalcitonin of 1 ± 0.4 ng/ml. Data demonstrate that, in contrast to the acute phase reactant interleukin-6, plasma levels procalcitonin are not significantly elevated during uncomplicated acute myocardial infarction. This observation may support the role of procalcitonin measurements in the differential diagnosis of infectious and cardiovascular complications after major surgery.     

无复流现象对急性心肌梗死患者经皮冠状动脉腔内介人治疗时机选择的影响

目的比较研究急性心肌梗死患者行经皮冠状动脉腔内介入治疗(PCI)的时机选择与慢血流/无复流(SNR)现象的关系。方法选择272例急性心肌梗死行PCI治疗的患者为研究对象。TIMI2级血流患者136例,其中60例24h内施行即刻PCI,28例在梗死后24h至一周施行PCI,48例一周后至一月内行PCI;TIMI3级血流患者136例,其中62例在急性心肌梗死发病24h内行PCI,31例发病24h至一周内行PCI,43例一周后至一月内行PCI。分别比较各组的一般情况,冠脉造影梗死相关血管(IRA)行PCI前后的血流情况。结果TIMI2级血流组和TIMI3级血流组中24h至一周内行PCI治疗的患者SNR发生率显著高于24h内即刻PCI组和一周后择期PCI组(8/60vs22/28,22/28vs16/48,P均<0.05)(14/31vs6/62,14/31vs4/43,P均<0.05),且在TIMI2级血流组中即刻PCI组的SNR发生率明显低于一周后择期PCI组(8/60vs16/48,P<0.05);TIMI3级血流组中即刻PCI组的SNR发生率与一周后择期PCI组无差异(6/62vs4/43,P<0.05);TIMI2级与TIMI3级血流组在24h至一周内行PCI的患者SNR的发生率差异显著(22/28vs14/31,P<0.05)。结论急性心肌梗死患者即刻PTCA的血流恢复优于择期PTCA,尤其TIMI血流≤2级的患者。     

急性心肌梗死患者排便意愿的调查研究

目的 了解急性心肌梗死患者住院期间的排便意愿,以便更好为患者提供优质护理服务提供依据。方法 采用问卷调查法对符合纳入标准的200例急性心肌梗死患者进行住院期间排便意愿的调查,最终获得195例有效问卷,采用自制排便意愿调查表进行调查。结果 参与调查的195例急性心肌梗死患者中,192例（98.46%）患者习惯蹲位或坐位的排便方式;在病情允许的情况下,急性心肌梗死患者中更倾向于选择入厕排便187人次（83.85%）,倾向于床旁入厕的共31人次（13.90%）;且112例（57.44%）患者认为床上排便的方式对自身影响很大,更有34例患者宁可不排便;131例（67.18%）有拒绝床上排便的想法,急性心肌梗死114人次（59.69%）是患者拒绝床上排便的主要原因排便习惯的改变。结论 床上排便方式给急性心肌梗死患者带来诸多不愉快的住院体验,大多数急性心肌梗死患者对于床旁或入厕排便有极大的意愿请求。在充分评估患者病情,妥善监护的基础上,医护人员应尊重患者的排便意愿及需求。     

Circulating microRNAs: A Potential Role in Diagnosis and Prognosis of Acute Myocardial Infarction

Rapid and correct diagnosis of acute myocardial infarction (AMI) plays a crucial role in saving patients'' life. Although some biomarkers (such as cardiac troponin and creatine kinase) are available for AMI diagnosis so far, there is still a clinical need for novel biomarkers, which can reliably rule in or rule out AMI immediately on admission. Circulating microRNAs (miRNAs) are a potential choice for novel biomarkers in AMI diagnosis and prognosis with high sensitivity and specificity. Circulating microRNAs are endogenous miRNAs that are detectable in whole blood, serum, or plasma in a highly stable form. Until now, around 20 circulating miRNAs were reported to be closely associated with AMI. In this minireview, we summarized recent available data on the correlation between circulating miRNAs and AMI. Some miRNAs, such as miR-208, miR-499, miR-133, and miR-1, were given special attention, since they may have a potential prospect in diagnosis and prognosis of AMI.     

急性重症心肌炎酷似急性心肌梗死样图形改变1例

目的：探讨酷似急性心肌梗死的急性重症心肌炎的临床特点和心电图图形改变。方法回顾性分析了1例酷似急性心肌梗死样图形改变的急性重症心肌炎患者的临床资料及心电图。结果本例患者及时给予减轻心脏负荷、抗病毒、对症支持治疗,病情缓解后出院。结论酷似急性心肌梗死的急性重症心肌炎可通过心电图表现、心肌酶检查结果与急性心肌梗死进行鉴别。早诊断、早治疗有助于提高疗效。