ST段抬高型心肌梗死诊疗策略的临床观察

目的：比较2004年与2010年ST段抬高型心肌梗死（STEMI）诊疗策略的变化,分析其与指南的差距。方法：回顾性研究152例STEMI患者（2004年37例,2010年115例）临床资料,对比分析其住院期间诊断治疗策略的差异并了解其与指南差距。结论：STEMI患者近6年来住院诊疗策略进步明显,尤其是有创检查及治疗部分,但临床实践与循证指南仍存在不少差距,特别是GPUb／Ⅲa抑制剂使用、早期再灌注治疗上仍有待提高。     

白细胞计数和血小板计数联合评分对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后在院死亡危险评估的研究

目的：探讨白细胞计数和血小板计数联合评分(COL-P评分)对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术后在院死亡危险评估的效果。方法：回顾性研究我院2009-11至2013-08的STEMI住院急诊行PCI术的患者共660例,其中生存者572例,死亡者88例。依不同COL-P评分进行分组（COL-P 0分组、COL-P 1分组、COL-P 2分组）统计学分析。结果：660例急诊行PCI术的STEMI患者住院期间死亡者88例。死亡者白细胞计数高于生存者白细胞计数,两者比较差异有统计学意义（P<0.001）;死亡者血小板计数低于生存者血小板计数,两者比较差异有统计学意义（P<0.01）。Logistic回归显示,COL-P评分[COL-P（1 vs 0）,OR 4.346,95% CI：2.134-8.850,P<0.001; COL-P(2 vs 0), OR 10.126,95% CI：4.061-25.250,P<0.001]为STEMI患者急诊PCI术后在院死亡的独立影响因素。COL-P 0分组、COL-P 1分组和COL-P 2分组在院期间死亡率分别为4.9%、15.4%和43.1%,三组比较差异有统计学意义（P<0.001）。结论：COL-P评分是STEMI患者急诊PCI术后住院期间死亡率危险评估的良好评价工具,但对长期死亡率的评估能力还有待进一步研究验证。     

急诊室使用替罗非班对IRA再通和TIMI血流的影响

目的探讨急诊室给予替罗非班对ST段抬高型急性心肌梗死(STEMI)患者梗死相关动脉(IRA)再通和经皮冠状动脉介入(PCI)术后即刻心肌灌注的影响。方法治疗组47例患者PCI术前在急诊室给予替罗非班,对照组50例患者在PCI术中给予替罗非班,观察两组急诊造影中IRA再通率、PCI术后即刻靶血管TIMI血流分级及不良反应发生率。结果急诊造影时IRA再通率(38.29%)显著高于对照组(20.00%),两组差异有统计学意义(P<0.05)。急诊造影时TIMI血流Ⅲ级患者治疗组(34.04%)显著高于对照组(10.00%),两组比较差异有统计学意义(P<0.05)。术后即刻靶血管TIMI血流Ⅲ级患者治疗组(93.62%)显著高于对照组(76.00%),两组比较差异有统计学意义(P<0.05)。结论 STEAMI患者PCI术前急诊室即予替罗非班治疗能提高急诊造影时IRA再通率,改善术后即刻心肌灌注,且安全性好。     

非急性心肌梗死ST段抬高的临床意义

心电图ST段抬高主要见于急性心肌梗死,但心电图ST段抬高还可以在其它情况出现。本综述的目的是描述其他心电图上类似心肌梗死的ST段抬高的各种情况,找出与之区分的线索。     

Association of Fragmented QRS Complex with Myocardial Reperfusion in Acute ST‐Elevated Myocardial Infarction

In this study, we aimed to evaluate the relationship between TIMI myocardial perfusion (TMP) grade, as an indicator of myocardial reperfusion, and fragmented QRS (fQRS) in standard 12‐lead electrocardiogram. Also, we evaluate fQRS is an additional indicator of myocardial reperfusion. One hundred patients admitted with first STEMI to Coronary Intensive Care Unit and who were used thrombolytic therapy was included in this retrospective study. Standard 12‐lead electrocardiogram records of patients simultaneous with coronary angiography (second day) were assessed and analysed for the presence of fQRS. Also, coronary angiography images were analyzed to identify the infarct related artery, TIMI grade of infarct related artery and TMP grade of infarct related artery. The patients with fQRS demonstrated a significantly lower TMP grade, TIMI grade and ejection fraction compared with the non‐fQRS patients (P = 0.004, P = 0.003, P = 0.02 respectively). The patients with inadequate myocardial reperfusion demonstrated a significantly higher fQRS compared with the adequate myocardial reperfusion patients. (56.9% versus 23.5%, P = 0.002 respectively). On correlation analysis, there was a significant negative correlation between fQRS and left ventricular ejection fraction (r = ?232, P = 0.02) TMP grade and adequate myocardial reperfusion (TMP 3) showed significant negative correlation with fQRS (r = ?0.370, P = 0.000; r = ?0.318, P = 0.001 respectively). Presence of fragmented QRS in STEMI patients was associated with inadequate myocardial reperfusion and it can be used as a simple, noninvasive parameter to evaluate myocardial reperfusion.     

Clinical Outcomes of Primary Angioplasty in ST Elevation Myocardial Infarction Patients With Antecedent Hypertension During Hospital Stay and Follow-up

Hypertension is a known risk factor for coronary artery disease. However, the number of studies focusing on the events following ST elevation myocardial infarction (STEMI) in patients with an antecedent hypertension is limited. Our aim is to evaluate the clinical outcomes of primary angioplasty in STEMI patients with antecedent hypertension during hospital stay and follow-up. A total of 373 patients (177 of whom had antecedent hypertension) who were treated by primary angioplasty because of STEMI were included in this study. All parameters were compared between the groups with and without hypertension. Hypertensive patients who received primary angioplasty were older (59.9 ± 12.6 vs. 52 ± 12.3, P < .001) and had higher rates of in-hospital mortality and major adverse cardiac events than patients without hypertension. Among STEMI patients, only history of hypertension for more than 10 years was a predictor of in-hospital mortality (odds ratio: 4.374, 95% CI 1.017–18.822, P = .04). Patients with an antecedent hypertension have higher initial risk profiles and show more negative outcomes during a 6-month follow-up period.     

Unusual Evolution of ST Elevation Acute Myocardial Infarction

We report a case of acute ST‐segment elevation myocardial infarction with an unusual evolution of ST‐segment elevation. Several possible explanations of this progression are discussed with supportive evidence for each explaination. The clinical, electrocardiographic, and angiographic features of this case are also illustrated.     

急性心肌梗死新出现的束支传导阻滞与30天全因死亡率的关系

【摘要】目的：这篇文章的目的是为了探索急性心肌梗死的患者，心电图上出现束支传导阻滞的时间和持续时间与其30天全因死亡率之间的关系。方法：从2015年01月至2015年12月，我们共收集了1000例急性心肌梗死的患者，使用多元回归的方法分析了其30天全因死亡率与束支传导阻滞出现时间和持续时间之间的关系。结果：和右束支阻滞比较起来，左束支阻滞有更高的共病患病率和死亡率。暂时性束支传导阻滞30天全因死亡率更低。结论：急性心肌梗死的患者，新出现的永久性束支传导阻滞是30天全因死亡率的独立危险因素。     

Different Causes of Death in Patients with Myocardial Infarction Type 1, Type 2, and Myocardial Injury

Background

Data outlining the mortality and the causes of death in patients with type 1 myocardial infarction, type 2 myocardial infarction, and those with myocardial injury are limited.

Anxiety,Anger, and Mortality Risk among Survivors of Myocardial Infarction

Background

Although there is evidence that anxiety and anger are associated with a higher risk of cardiovascular events, studies examining the relationship between these stressors and prognosis following myocardial infarction have been mixed.

Methods

We conducted a prospective cohort study of 1968 participants (average age 60.2 years, 30.6% women) in the Determinants of Myocardial Infarction Onset Study recruited at the time of admission for myocardial infarction between 1989 and 1996. We used the state anxiety and anger subscales of the State-Trait Personality Inventory. Participants were followed for all-cause mortality through December 31, 2007 using the National Death Index. We constructed multivariable Cox proportional hazards models adjusted for demographic, behavioral, and clinical confounders and calculated hazard ratios (HR) and 95% confidence intervals (CI) to examine the relationship between high levels of anxiety and anger and all-cause mortality.

Results

Over 10 years of follow-up, 525 participants died. Compared with those scoring lower, an anxiety score >90^th percentile was associated with a 1.31-times (95% CI, 0.93-1.84) higher mortality rate. The association was apparent in the first 3 years (HR 1.78; 95% CI 1.08-2.93), but not thereafter. Likewise, an anger score >90^th percentile was associated with a 1.25-times (95% CI, 0.87-1.80) higher mortality rate. The association was higher in the first 3 years (HR 1.58; 95% CI, 0.91-2.74) than in subsequent years, but it was not statistically significant during either follow-up period.

Conclusions

In this study of myocardial infarction survivors, a high level of anxiety was associated with all-cause mortality, with the strongest association in the first 3 years of follow-up.     

Four-year Incidence of Myocardial Infarction and Sudden Coronary Death in Twelve Finnish Population Cohorts

ABSTRACT. Suhonen O, Reunanen A, Aromaa A, Knekt P, PyÖrÄlÄ K. (Research Institute for Social Security, Social Insurance Institution, Helsinki, Finland.) Four-year incidence of myocardial infarction and sudden coronary death in twelve Finnish population cohorts. The incidence of myocardial infarction (MI) and sudden coronary death in four years was studied in 6510 men and 5800 women, aged 30–59 years, derived from 12 Finnish population cohorts constituting the invited population to a prospective study. The incidence of all fatal coronary events in four years was 13.0/1000 in men and 1.8/1000 in women. The incidence of sudden coronary death was 7.8/1000 in men and 0.7/1000 in women. The incidence of non-fatal MI was 22.2/1000 in men and 7.3/1000 in women. Coronary mortality was significantly higher in non-participants in the initial survey than in participants. The incidence of MI was highest in men from eastern Finland (North Karelia), intermediate in men from central and western Finland and lowest in men from southwestern Finland. There were no significant regional differences in the incidence of MI in women. The incidence of MI in this study was in good agreement with that recorded in the myocardial community registers.     

QT Interval and the Risk of Myocardial Infarction and All-Cause Death: A Cohort Study

QT Interval and the Risk of Myocardial Infarction and All‐Cause Death . Introduction: The relationship between QT interval and cardiovascular disease is controversial. Methods: All male residents aged 20–61 years and female residents aged 20–56 years were invited to the Tromsø Study in 1986–1987. A total of 15,558 participants free of heart disease were prospectively followed over 20 years for myocardial infarction and death. QT interval at baseline was measured on lead I of the electrocardiogram. Hazard ratios (HRs) with 95% confidence intervals (CIs) per standard deviation change in QT interval were calculated using a Cox regression model. Results: We identified 756 cases of myocardial infarction and 1,183 all‐cause deaths. Prolonged QT interval was present in 792 (5%) participants. QT interval was not associated with increased risk of myocardial infarction (HR: 0.95, 95% CI: 0.84–1.07, after adjustment for potential confounders). Heart‐rate‐corrected QT interval was a significant predictor for all‐cause death in men (HR: 1.15, 95% CI: 1.03–1.29), but not in women (HR: 1.04, 95% CI: 0.91–1.18), after adjustment for potential confounders. Conclusions: The findings suggest that the previously observed relationship between QT interval and increased risk of cardiovascular death is not mediated by increased risk of myocardial infarction. The clinical utility of the QT interval to identify individuals at high risk for coronary events is limited in a general population without prior heart disease. (J Cardiovasc Electrophysiol, Vol. 23, pp. 846‐852, August 2012)     

Patients with Tombstoning Pattern on the Admission Electrocardiography Who Have Undergone Primary Percutaneous Coronary Intervention for Anterior Wall ST‐Elevation Myocardial Infarction: In‐Hospital and Midterm Clinical Outcomes

Background: A tombstoning pattern (T‐pattern) is associated with in‐hospital poor outcomes patients with ST‐segment elevation myocardial infarction (STEMI), but no data are available for midterm follow‐up. We sought to determine the prognostic value of a T‐pattern on admission electrocardiography (ECG) for in‐hospital and midterm mortality in patients with anterior wall STEMI treated with primary percutaneous coronary intervention (PCI). Methods: After exclusion, 169 consecutive patients with anterior wall STEMI (mean age: 55 ± 12.9 years; 145 men) undergoing primary PCI were prospectively enrolled in this study. Patients were classified as a T‐pattern (n = 32) or non–T‐pattern (n = 137) based upon the admission ECG. Follow‐up to 6 months was performed. Results: In‐hospital mortality tended to be higher in the T‐pattern group compared with non–T‐pattern group (9.3% vs 2.1% respectively, P = 0.05). All‐cause mortality was higher in the T‐pattern group than non–T‐pattern group for 6 month (P = 0.004). After adjusting the baseline characteristics, the T‐pattern remained an independent predictor of 6‐month all‐cause mortality (odds ratio: 5.18; 95% confidence interval: 1.25–21.47, P = 0.02). Conclusion: A T‐pattern is a strong independent predictor of 6‐month all‐cause mortality in anterior STEMI treated with primary PCI. Therefore, it may be an indicator of high risk among patients with anterior wall STEMI.     

急性心肌梗塞早期墓碑形ST段抬高的临床意义

目的探讨墓碑形ＳＴ段升高在急性心梗早期中表现的意义。方法通过５８例伴高血压或不伴高血压的急性心梗病人的出现墓碑状ＳＴ段抬高，并与６０例无出现此种ＳＴ段变化的急性心梗病人作症状和预后的比较分析。结果出现墓碑形抬高的高血压急性心梗患者的ＰＴＦＶ１阳性、ＱＲＳ低电压、对应性ＳＴ段下移、ＱＴｃ间期延长、梗塞部位多在前壁或复合前壁、泵衰竭、恶性心律失常、心梗扩展、１周内死亡率及合并脑出血均较其他各组增高。结论墓碑形ＳＴ段抬高是高血压患者发生急性心梗时出现的一种表示严重心肌损伤和预后险恶的一种独立指征。     

急性心肌梗塞患者住院死亡率女性高于男性原因探讨

本文对181例女性和214例男性急性心肌梗塞(AMI)住院患者的资料进行分析.结果发现,住院期间女性AMI的死亡率明显高于男性(26%与14%;P<0.01).女性AMI患者具有发病年龄大、胸痛少、糖尿病较多、广泛前壁及复合部位梗塞较多、血清肌酸磷酸肌酶水平较低,心源性并发症多等特点.多因素回归分析表明,年龄、心绞痛、糖尿病、心力衰竭及休克为预示女性AMI死亡的重要因素.